Individual
DR. JASON NEIL HURLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
527 RIGBY LAKE DR, SUITE C, RIGBY, ID 83442-1271
(208) 745-0181
(208) 745-1121
Mailing address
527 RIGBY LAKE DR, SUITE C, RIGBY, ID 83442-1271
(208) 745-0181
(208) 745-1121
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100063
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP-100063
ID
152WP0200X
Pediatric Optometrist
ODP-100063
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147608
BLUE SHIELD
ID
05
—
806929900
—
ID
01
—
DC5197
RAILROAD MEDICARE
ID
01
—
V6531
BLUE CROSS
ID
Enumeration date
04/10/2006
Last updated
05/16/2014
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