Provider Demographics
NPI:1235339953
Name:DUBBELS, PAUL LEE (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LEE
Last Name:DUBBELS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S POKEGAMA AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3933
Mailing Address - Country:US
Mailing Address - Phone:218-326-1775
Mailing Address - Fax:218-326-3745
Practice Address - Street 1:710 S POKEGAMA AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3933
Practice Address - Country:US
Practice Address - Phone:218-326-1775
Practice Address - Fax:218-326-3745
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist