Provider Demographics
NPI:1922238765
Name:HURLEY, YASEMIN DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:YASEMIN
Middle Name:DAWN
Last Name:HURLEY
Suffix:
Gender:F
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:PO BOX 2580
Mailing Address - Street 2:P.O. BOX 488
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR
Practice Address - Street 2:STE 240 A
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2931
Practice Address - Country:US
Practice Address - Phone:573-458-6310
Practice Address - Fax:573-458-6791
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010226152W00000X
MO2010004182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1922238765Medicaid
ILIL2729002OtherPTAN
MOP01102854OtherRR MCR
MO431560263OtherTRICARE
MO431560263OtherTRICARE