Healthcare Provider Details

I. General information

NPI: 1235191198
Provider Name (Legal Business Name): MATTHEW JOHN HURST OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 WEST HIGH AVE
NEW PHILADELPHIA OH
44663
US

IV. Provider business mailing address

163 WEST HIGH AVE
NEW PHILADELPHIA OH
44663
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-0145
  • Fax: 330-343-1240
Mailing address:
  • Phone: 330-343-0145
  • Fax: 330-343-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4748
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: