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NPI Code Detail

MEDICARE: DR. PAUL CLARENCE JUBB OD

MEDICARE: DR. PAUL CLARENCE JUBB OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOD00001723WA

General Provider Information

NPI Number : 1285739466
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL CLARENCE JUBB OD
Provider Business Mailing Address
First Line : 1415 72ND DR SE
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-7356
Country : US
Telephone Number : 509-240-4343
Fax Number :
Provider Business Practice Location Address
First Line : 2301 FREEWAY DR
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-5445
Country : US
Telephone Number : 360-482-5033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 05/16/2019

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Directions to “ DR. PAUL CLARENCE JUBB OD” Practice Location

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