Provider Demographics
NPI:1841249828
Name:HUBBARD, GARY CARL (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:CARL
Last Name:HUBBARD
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 1:608 TRENT ST NE
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1532
Mailing Address - Country:US
Mailing Address - Phone:276-679-0536
Mailing Address - Fax:206-279-9117
Practice Address - Street 1:608 TRENT ST NE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1532
Practice Address - Country:US
Practice Address - Phone:276-679-0536
Practice Address - Fax:206-279-9117
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU09814Medicare UPIN
VA00X134O01Medicare PIN