1003095118 NPI number — HUBER EYECARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003095118 NPI number — HUBER EYECARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUBER EYECARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUBER EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003095118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2711 COMMERCE DR NW
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901-2262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-206-4567
Provider Business Mailing Address Fax Number:
507-206-4568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1161 MAINE AVE SE #4430
Provider Second Line Business Practice Location Address:
TARGET OPTICAL
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-206-5020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUBER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
TY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-802-5829

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2967 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)