Provider Demographics
NPI:1215042742
Name:HUBBELL, CARRIE NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:NICOLE
Last Name:HUBBELL
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 1:1144 AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4613
Mailing Address - Country:US
Mailing Address - Phone:443-482-3816
Mailing Address - Fax:
Practice Address - Street 1:509 S CHERRY GROVE AVE
Practice Address - Street 2:SPECTACULAR EYE CARE, SUITE C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4244
Practice Address - Country:US
Practice Address - Phone:410-268-4393
Practice Address - Fax:410-268-5200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1798152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist