Provider Demographics
NPI:1730243361
Name:HUBER, DAVID (OD)
Entity type:Individual
Prefix:PROF
First Name:DAVID
Middle Name:
Last Name:HUBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 W KAREN LEE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3778
Mailing Address - Country:US
Mailing Address - Phone:623-876-9283
Mailing Address - Fax:
Practice Address - Street 1:13943 N 91ST AVE
Practice Address - Street 2:BLDG. G
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3687
Practice Address - Country:US
Practice Address - Phone:623-561-1995
Practice Address - Fax:623-561-2446
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162076Medicare PIN
AZZ163927Medicare PIN
AZZ163923Medicare PIN
AZZ163925Medicare PIN
AZZ162077Medicare PIN
AZZ163924Medicare PIN
AZZ162079Medicare PIN
AZZ162078Medicare PIN
AZZ162074Medicare PIN
AZZ162075Medicare PIN
AZZ163922Medicare PIN
AZZ163926Medicare PIN