Provider Demographics
NPI:1770686982
Name:EDWARD P HURST MD PA
Entity Type:Organization
Organization Name:EDWARD P HURST MD PA
Other - Org Name:ROCKWALL EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-771-2020
Mailing Address - Street 1:2380 S GOLIAD ST. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-9998
Mailing Address - Country:US
Mailing Address - Phone:972-771-2020
Mailing Address - Fax:972-722-4858
Practice Address - Street 1:2380 S GOLIAD ST., STE. 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9998
Practice Address - Country:US
Practice Address - Phone:972-771-2020
Practice Address - Fax:972-722-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9603207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080943601Medicaid
TX0161270001Medicare NSC