Individual
MRS. LAUREN MARIE HUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
27 N FISHER PARK WAY, SUITE 101, EAGLE, ID 83616-4796
(208) 514-1858
Mailing address
2563 W TANGO CREEK DR, MERIDIAN, ID 83646-5996
(207) 233-3633
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1000250
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20001413
MEDICARE PTAN
ID
Enumeration date
06/20/2012
Last updated
07/12/2016
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