Provider Demographics
NPI:1457453698
Name:HUBBELL, GERARD H (OD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:H
Last Name:HUBBELL
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:PO BOX 207151
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7151
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:924 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803
Practice Address - Country:US
Practice Address - Phone:863-688-6197
Practice Address - Fax:863-688-7508
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068250001OtherD-MERC
FL084971500Medicaid
FL0682520001Medicare NSC
FL068250001OtherD-MERC
FL084971500Medicaid
T84107Medicare UPIN