Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | C003289-1 | NY |
N | 156FX1800X | Optician | C003289-1 | NY |
NPI | 1295869204 |
---|---|
Provider Name | Mr. Ralph John Hubert JR. |
First Address | Batavia, NY 14020-3242 |
Second Address | Batavia, NY 14020-3242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00633349 | (05) | NY |