Provider Demographics
NPI:1811424724
Name:HUBER, JAY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MICHAEL
Last Name:HUBER
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 1:10024 SE 240TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5124
Mailing Address - Country:US
Mailing Address - Phone:532-852-5440
Mailing Address - Fax:253-852-0272
Practice Address - Street 1:10024 SE 240TH ST STE 220
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5124
Practice Address - Country:US
Practice Address - Phone:532-852-5440
Practice Address - Fax:253-852-0272
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60769647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty