Provider Demographics
NPI:1467681122
Name:HUBBARD, KRISTOPHER THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:THOMAS
Last Name:HUBBARD
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 490
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0490
Mailing Address - Country:US
Mailing Address - Phone:308-762-3124
Mailing Address - Fax:308-762-7326
Practice Address - Street 1:515 NIOBRARA AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3421
Practice Address - Country:US
Practice Address - Phone:308-762-3124
Practice Address - Fax:308-762-7326
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE134259627OtherRAILROAD MEDICARE GA
NE06748OtherBLUE CROSS BLUE SHIELD
NE134259627OtherRAILROAD MEDICARE GA
NE4971810002Medicare NSC
NE4971810001Medicare NSC
NE06748OtherBLUE CROSS BLUE SHIELD
NEP00238511Medicare PIN