Provider Demographics
NPI:1962501734
Name:HUBER, LANCE EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:EDWARD
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 1:7960 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3715
Mailing Address - Country:US
Mailing Address - Phone:972-401-2000
Mailing Address - Fax:972-910-8520
Practice Address - Street 1:7960 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3715
Practice Address - Country:US
Practice Address - Phone:972-401-2000
Practice Address - Fax:972-910-8520
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5130TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU58156Medicare UPIN
TX8F0481Medicare ID - Type Unspecified