Provider Demographics
NPI:1972572899
Name:LUBERT, GERALD P (OD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:P
Last Name:LUBERT
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 1:1932 ALCOA HWY
Mailing Address - Street 2:STE 255
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1508
Mailing Address - Country:US
Mailing Address - Phone:865-244-2030
Mailing Address - Fax:865-684-1196
Practice Address - Street 1:1932 ALCOA HWY STE 255
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1508
Practice Address - Country:US
Practice Address - Phone:865-244-2030
Practice Address - Fax:865-684-1196
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0943152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
2240396OtherUNITED HEALTHCARE
3333333OtherUMWA
410030911OtherRAILROAD MEDICARE
5928759OtherCIGNA
100026729OtherPHP
TN3599503Medicaid
86314OtherBLUE CROSS BLUE SHIELD
410030911OtherRAILROAD MEDICARE
TN3599503Medicaid
TN3599505Medicare ID - Type Unspecified