Provider Demographics
NPI:1275617540
Name:HURTUBISE, JANICE F (OD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:F
Last Name:HURTUBISE
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 1:14815 NE 5TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-5769
Mailing Address - Country:US
Mailing Address - Phone:360-571-2473
Mailing Address - Fax:360-571-2473
Practice Address - Street 1:9317 NE HIGHWAY 99
Practice Address - Street 2:SUITE D
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8900
Practice Address - Country:US
Practice Address - Phone:360-571-3430
Practice Address - Fax:360-571-3492
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3555152W00000X
OR2771ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030633Medicaid
WA8850531Medicare ID - Type UnspecifiedDOCTOR NUMBER
WA2030633Medicaid