Provider Demographics
NPI:1689665705
Name:HUEBSCH, RONALD (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:HUEBSCH
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 1:523 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1603
Mailing Address - Country:US
Mailing Address - Phone:763-389-3150
Mailing Address - Fax:763-389-0664
Practice Address - Street 1:523 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1603
Practice Address - Country:US
Practice Address - Phone:763-389-3150
Practice Address - Fax:763-389-0664
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2115731OtherMEDICA MATERIALS
MN2202702OtherMEDICA HEALTH CARE PLAN
5C026HUOtherBC/BS (MATERIALS)
960380688001OtherPREFERRED ONE
4676OtherHEALTH PARTNERS
52393HUOtherBLUE CROSS/BLUE SHIELD
MN584823700Medicaid
MN115240OtherU-CARE
MN2202702OtherMEDICA HEALTH CARE PLAN
MN419000530Medicare ID - Type Unspecified
0648040001Medicare NSC