=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093780504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANICE F HURTUBISE, OD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9317 NE HIGHWAY 99 SUITE D
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98665-8900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-571-3430
-----------------------------------------------------
Fax | 360-571-3492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14815 NE 5TH CT
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-5769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-571-3430
-----------------------------------------------------
Fax | 360-571-3492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JANICE F HURTUBISE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 360-571-3430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3555
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------