Healthcare Provider Details

I. General information

NPI: 1639808926
Provider Name (Legal Business Name): GREGORY HURD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LETTON DR
PARIS KY
40361-2252
US

IV. Provider business mailing address

305 LETTON DR
PARIS KY
40361-2252
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-4686
  • Fax: 859-987-4680
Mailing address:
  • Phone: 859-987-4686
  • Fax: 859-987-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number110575
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: