Provider Demographics
NPI:1033269790
Name:FURST, HERBERT NORMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:NORMAN
Last Name:FURST
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 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:14139 POTOMAC MILLS ROAD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:20192-4644
Practice Address - Country:US
Practice Address - Phone:703-490-7606
Practice Address - Fax:703-490-7824
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA0790152W00000X
VA0618000786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
006994M92Medicare ID - Type Unspecified
T73487Medicare UPIN