Provider Demographics
NPI:1417912635
Name:HURLBUT, FREDERICK JAMES JR (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JAMES
Last Name:HURLBUT
Suffix:JR
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 1:942 S COVE WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5110
Mailing Address - Country:US
Mailing Address - Phone:303-744-6264
Mailing Address - Fax:303-765-0429
Practice Address - Street 1:1573 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3704
Practice Address - Country:US
Practice Address - Phone:303-782-0470
Practice Address - Fax:303-782-0474
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist