Healthcare Provider Details

I. General information

NPI: 1275617540
Provider Name (Legal Business Name): JANICE F HURTUBISE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9317 NE HIGHWAY 99 SUITE D
VANCOUVER WA
98665-8900
US

IV. Provider business mailing address

14815 NE 5TH CT
VANCOUVER WA
98685-5769
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-3430
  • Fax: 360-571-3492
Mailing address:
  • Phone: 360-571-2473
  • Fax: 360-571-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3555
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2771ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: