Provider Demographics
NPI:1679270474
Name:HUBBARD, KARIEN NICOLE (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:KARIEN
Middle Name:NICOLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 ATLANTIC BLVD NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-3933
Mailing Address - Country:US
Mailing Address - Phone:330-489-9145
Mailing Address - Fax:330-489-9147
Practice Address - Street 1:3200 ATLANTIC BLVD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3933
Practice Address - Country:US
Practice Address - Phone:330-489-9145
Practice Address - Fax:330-489-9147
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.014377S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician