Provider Demographics
NPI:1598768731
Name:HUBER, JANET L (OD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:HUBER
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 1:1022 W IVY AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4107
Mailing Address - Country:US
Mailing Address - Phone:509-765-7845
Mailing Address - Fax:509-765-5192
Practice Address - Street 1:1022 W IVY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4107
Practice Address - Country:US
Practice Address - Phone:509-765-7845
Practice Address - Fax:509-765-5192
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00002028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026623Medicaid
WAAB29928Medicare ID - Type Unspecified
WAU36661Medicare UPIN