Provider Demographics
NPI:1659596351
Name:LUBISICH, CARL A (HEARING INSTRUMENT T)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:A
Last Name:LUBISICH
Suffix:
Gender:M
Credentials:HEARING INSTRUMENT T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N US HIGHWAY 89
Mailing Address - Street 2:NORTHERN ARIZONA VA HCS
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313
Mailing Address - Country:US
Mailing Address - Phone:928-445-4860
Mailing Address - Fax:928-717-7553
Practice Address - Street 1:500 N US HIGHWAY 89
Practice Address - Street 2:NORTHERN ARIZONA VA HCS
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:928-717-7553
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD1558237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist