Provider Demographics
NPI:1265617641
Name:RONALD F HUEBSCH OD
Entity type:Organization
Organization Name:RONALD F HUEBSCH OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUEBSCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-389-3150
Mailing Address - Street 1:523 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1603
Mailing Address - Country:US
Mailing Address - Phone:763-389-3150
Mailing Address - Fax:763-389-0664
Practice Address - Street 1:523 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1603
Practice Address - Country:US
Practice Address - Phone:763-389-3150
Practice Address - Fax:763-389-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1783332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN584823700Medicaid
MN584823700Medicaid
MN0648040001Medicare NSC
MN419000530Medicare PIN