Provider Demographics
NPI:1295869204
Name:HUBERT, RALPH JOHN JR (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:JOHN
Last Name:HUBERT
Suffix:JR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3242
Mailing Address - Country:US
Mailing Address - Phone:585-343-5660
Mailing Address - Fax:585-343-5882
Practice Address - Street 1:31 CENTER ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3242
Practice Address - Country:US
Practice Address - Phone:585-343-5660
Practice Address - Fax:585-343-5882
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003289-1156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00633349Medicaid