Provider Demographics
NPI:1295841302
Name:HUEBENER, WAYNE STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:STEVEN
Last Name:HUEBENER
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:VISION 4 LESS
Mailing Address - Street 2:1810 N. CORAL STREET
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-246-5623
Mailing Address - Fax:319-351-2182
Practice Address - Street 1:VISION 4 LESS
Practice Address - Street 2:1810 N. CORAL STREET
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-246-5623
Practice Address - Fax:319-351-2182
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA063289Medicare ID - Type Unspecified
IAUO1725Medicare UPIN