Provider Demographics
NPI:1659625895
Name:HUBER, DORTHEA K (OD)
Entity Type:Individual
Prefix:
First Name:DORTHEA
Middle Name:K
Last Name:HUBER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DORTHEA
Other - Middle Name:K
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1127 SE DALE ST
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5536
Mailing Address - Country:US
Mailing Address - Phone:509-886-0924
Mailing Address - Fax:509-886-2117
Practice Address - Street 1:375 HIGHLINE DR
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5344
Practice Address - Country:US
Practice Address - Phone:509-886-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60298050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist