Provider Demographics
NPI:1629272323
Name:JASON N HURLEY O.D., PC
Entity Type:Organization
Organization Name:JASON N HURLEY O.D., PC
Other - Org Name:EYECARE OF RIGBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-745-0181
Mailing Address - Street 1:711 RIGBY LAKE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5334
Mailing Address - Country:US
Mailing Address - Phone:208-745-0181
Mailing Address - Fax:208-745-1121
Practice Address - Street 1:711 RIGBY LAKE DR STE 301
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5334
Practice Address - Country:US
Practice Address - Phone:208-745-0181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806929900Medicaid
ID5293100001OtherNORIDIAN
IDV6531OtherBLUE CROSS OF IDAHO
ID000010147608OtherREGENS BLUE SHIELD OF IDA
ID=========OtherMUTUAL OF OMAHA
ID000010147608OtherREGENS BLUE SHIELD OF IDA
ID5293100001Medicare NSC