Provider Demographics
NPI:1942308309
Name:HAGEN, HUBERTINA JM (OD)
Entity Type:Individual
Prefix:DR
First Name:HUBERTINA
Middle Name:JM
Last Name:HAGEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 E TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4570
Mailing Address - Country:US
Mailing Address - Phone:918-227-3937
Mailing Address - Fax:888-972-5679
Practice Address - Street 1:1029 E TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4570
Practice Address - Country:US
Practice Address - Phone:918-227-3937
Practice Address - Fax:888-972-5679
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2243152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100767760AMedicaid
OK4440680001Medicare NSC