Provider Demographics
NPI:1801859889
Name:HURLEY, JASON NEIL (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:NEIL
Last Name:HURLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:527 RIGBY LAKE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1271
Mailing Address - Country:US
Mailing Address - Phone:208-745-0181
Mailing Address - Fax:208-745-1121
Practice Address - Street 1:527 RIGBY LAKE DR
Practice Address - Street 2:SUITE C
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1271
Practice Address - Country:US
Practice Address - Phone:208-745-0181
Practice Address - Fax:208-745-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100063152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDC5197OtherRAILROAD MEDICARE
IDV6531OtherBLUE CROSS
ID000010147608OtherBLUE SHIELD
ID806929900Medicaid
IDV00885Medicare UPIN
ID5293100001Medicare NSC
ID1594276Medicare PIN