Provider Demographics
NPI:1225020910
Name:HURSH, ROSILAND LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSILAND
Middle Name:LYNN
Last Name:HURSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8269 SW WILSONVILLE RD STE G
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7719
Mailing Address - Country:US
Mailing Address - Phone:503-685-9015
Mailing Address - Fax:503-682-8696
Practice Address - Street 1:8269 SW WILSONVILLE RD STE G
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7719
Practice Address - Country:US
Practice Address - Phone:503-685-9015
Practice Address - Fax:503-682-8696
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2690ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
300200802OtherBLUE CROSS HMO/FC 65
831474002OtherBLUE CROSS BLUE SHIELD
831474002OtherBLUE CROSS BLUE SHIELD
200837727OtherEIN
U90891Medicare UPIN