Provider Demographics
NPI:1295748341
Name:HUBBARD, JOHN W (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:626 PARK ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431
Practice Address - Country:US
Practice Address - Phone:570-253-1720
Practice Address - Fax:570-253-0841
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000548502Medicaid
HU289290OtherHIGH MARK BLUE SHIELD
15486OtherGELSINGER HEALTH PLAN
506554OtherAETNA
410024728OtherRAILROAD MEDICARE
15486OtherGELSINGER HEALTH PLAN
PA000548502Medicaid