Provider Demographics
NPI:1922594654
Name:HIBBS, TAYLOR (OD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:HIBBS
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 1:3201 UNIVERSITY DR E STE 140
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3487
Mailing Address - Country:US
Mailing Address - Phone:979-731-8446
Mailing Address - Fax:979-731-8275
Practice Address - Street 1:3201 UNIVERSITY DR E STE 140
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3487
Practice Address - Country:US
Practice Address - Phone:979-731-8446
Practice Address - Fax:979-731-8275
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9494T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI$$$$$$$$$OtherSOCIAL SECURITY