Provider Demographics
NPI:1134189368
Name:LUBANES, ALAN E (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:E
Last Name:LUBANES
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:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95634-0796
Mailing Address - Country:US
Mailing Address - Phone:530-333-1730
Mailing Address - Fax:530-333-1913
Practice Address - Street 1:6325 HWY 193
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:CA
Practice Address - Zip Code:95634
Practice Address - Country:US
Practice Address - Phone:530-333-1730
Practice Address - Fax:530-333-1913
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6735T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0067350Medicaid
CASD0067350Medicaid
CASD0067350Medicare ID - Type Unspecified
CA0399760001Medicare NSC
CA410009732Medicare PIN
CA1134189368Medicare PIN