Provider Demographics
NPI:1275580896
Name:HUBBARD, TONYA R (OD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:R
Last Name:HUBBARD
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 1:1965 BARING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434
Mailing Address - Country:US
Mailing Address - Phone:775-358-1020
Mailing Address - Fax:775-358-7951
Practice Address - Street 1:18601 WEDGE PARKWAY SUITE 2C
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-358-1020
Practice Address - Fax:775-358-7951
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY256T152W00000X
CO2069152W00000X
OR3585AT152W00000X
NV942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54185351Medicaid
CO54185351Medicaid
COD0003Medicare ID - Type Unspecified