Provider Demographics
NPI:1366241853
Name:HIBBETT, IRA KNEELAND JR
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:KNEELAND
Last Name:HIBBETT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8624 LILLIAN PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7556
Mailing Address - Country:US
Mailing Address - Phone:256-335-0268
Mailing Address - Fax:
Practice Address - Street 1:8624 LILLIAN PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7556
Practice Address - Country:US
Practice Address - Phone:256-335-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician