Provider Demographics
NPI:1306830856
Name:WEBB, HERBERT TUCKER III (OD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:TUCKER
Last Name:WEBB
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:TUCKER
Other - Last Name:WEBB
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1205 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1606
Mailing Address - Country:US
Mailing Address - Phone:608-754-3379
Mailing Address - Fax:608-741-1506
Practice Address - Street 1:1205 SUFFOLK DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1606
Practice Address - Country:US
Practice Address - Phone:608-754-3379
Practice Address - Fax:608-741-1506
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38596300Medicaid
WI000047645Medicare ID - Type Unspecified
WI38596300Medicaid