Provider Demographics
NPI:1457334740
Name:HUNT, MARK T (OD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:T
Last Name:HUNT
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 1:161 W 200 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-668-3840
Mailing Address - Fax:435-652-1516
Practice Address - Street 1:2650 E CRAIG ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:435-668-3840
Practice Address - Fax:435-652-1516
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV361152W00000X
UT375881-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502192Medicaid
NV39124Medicare ID - Type UnspecifiedPROVIDER NUMBER
UT4632280001Medicare NSC
NV100502192Medicaid
UTU76855Medicare UPIN