Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3032 | WI |
NPI | 1003834250 |
---|---|
Provider Name | Gregory N Hubertus |
First Address | Green Bay, WI 54303-4569 |
Second Address | Green Bay, WI 54303-4569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 11/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V07501 | (02) | WI |