Healthcare Provider Details

I. General information

NPI: 1821296732
Provider Name (Legal Business Name): HENRY F HURLEY OPTICIAN ABO CERTIFI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 LINDEN AVE
CARPINTERIA CA
93013-2045
US

IV. Provider business mailing address

914 LINDEN AVE
CARPINTERIA CA
93013-2045
US

V. Phone/Fax

Practice location:
  • Phone: 805-684-7373
  • Fax:
Mailing address:
  • Phone: 805-684-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number18417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: