Provider Demographics
NPI:1790750511
Name:HUBBARD EYE CLINIC
Entity Type:Organization
Organization Name:HUBBARD EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:870-741-2787
Mailing Address - Street 1:519 N WILLOW ST
Mailing Address - Street 2:PO BOX 2417
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3518
Mailing Address - Country:US
Mailing Address - Phone:870-741-2787
Mailing Address - Fax:870-741-6714
Practice Address - Street 1:519 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3518
Practice Address - Country:US
Practice Address - Phone:870-741-2787
Practice Address - Fax:870-741-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142170722Medicaid
ARCH8765OtherTRAVELERS/RAILROAD MEDICARE
AR410012113OtherRAILROAD MEDICARE
AR5C405Medicare PIN
AR142170722Medicaid