Healthcare Provider Details

I. General information

NPI: 1417912635
Provider Name (Legal Business Name): FREDERICK JAMES HURLBUT JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 S COLORADO BLVD
DENVER CO
80222-3704
US

IV. Provider business mailing address

942 S COVE WAY
DENVER CO
80209-5110
US

V. Phone/Fax

Practice location:
  • Phone: 303-782-0470
  • Fax: 303-782-0474
Mailing address:
  • Phone: 303-744-6264
  • Fax: 303-765-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1069
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: