Provider Demographics
NPI:1891875571
Name:LUBS, DAVID PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:LUBS
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 1:4201 COLDWATER RD
Mailing Address - Street 2:C/O LENSCRAFTERS
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1113
Mailing Address - Country:US
Mailing Address - Phone:260-484-7487
Mailing Address - Fax:260-482-4575
Practice Address - Street 1:4201 COLDWATER RD
Practice Address - Street 2:C/O LENSCRAFTERS
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1113
Practice Address - Country:US
Practice Address - Phone:260-484-7487
Practice Address - Fax:260-482-4575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU12091Medicare UPIN
IN138650GMedicare ID - Type Unspecified