Provider Demographics
NPI:1912911504
Name:HUBER, EMERY C (OD)
Entity Type:Individual
Prefix:DR
First Name:EMERY
Middle Name:C
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 1:2080 NORTH HIGHWAY 360
Mailing Address - Street 2:STE:125
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1400
Mailing Address - Country:US
Mailing Address - Phone:817-633-2020
Mailing Address - Fax:214-788-2373
Practice Address - Street 1:2080 NORTH HIGHWAY 360 #125
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1400
Practice Address - Country:US
Practice Address - Phone:817-633-2020
Practice Address - Fax:214-788-2373
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2519 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-1822552OtherTAX ID
TXDR3272OtherGROUP PTAN -RAILROAD RETIREMENT
TXDR3272OtherGROUP PTAN -RAILROAD RETIREMENT
TX75-1822552OtherTAX ID
TX8B8307Medicare PIN
TX8C7472Medicare PIN