Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO6480 | FL |
NPI | 1053772699 |
---|---|
Provider Name | Mr. Hubert Kebreau III |
First Address | Ft Lauderdale, FL 33311-6137 |
Second Address | Ft Lauderdale, FL 33311-6137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2016 |
Last Update Date | 09/03/2016 |