Provider Demographics
NPI:1588225833
Name:HUR, JOON BOAZ (OD)
Entity Type:Individual
Prefix:
First Name:JOON
Middle Name:BOAZ
Last Name:HUR
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 1:104 PLUMTREE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6095
Mailing Address - Country:US
Mailing Address - Phone:410-420-4054
Mailing Address - Fax:
Practice Address - Street 1:104 PLUMTREE RD STE 107
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-569-7173
Practice Address - Fax:410-569-7123
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist