Provider Demographics
NPI:1043202922
Name:LUBBEN, GERRIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:GERRIE
Middle Name:L
Last Name:LUBBEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S MONROE AVE
Mailing Address - Street 2:SHOPKO EYECARE CENTER
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5061
Mailing Address - Country:US
Mailing Address - Phone:641-424-8271
Mailing Address - Fax:641-424-2359
Practice Address - Street 1:615 S MONROE AVE
Practice Address - Street 2:SHOPKO EYECARE CENTER
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5061
Practice Address - Country:US
Practice Address - Phone:641-424-8271
Practice Address - Fax:641-424-2359
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0252080Medicaid
IAU78748Medicare UPIN
IAI17724Medicare PIN