=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851561575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR MARK C HURST OPTOMETRIST LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2008
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 WESTWOOD DR
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62864-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-242-7810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 WESTWOOD DR
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62864-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-242-7810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK CLAUDE HURST
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 618-242-7810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------