MEDICARE: DR. JAMES D HURT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	18002127B	IN
2	152WC0802X	Corneal and Contact Management Optometrist	1055DT	KY
3	152W00000X	Optometrist	1055DT	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	410024957	OTHER	IN	MEDICARE RAILROAD
11	410010011	OTHER	KY	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2200092	OTHER		UNITED HEALTHCARE
2	K001342	OTHER		TRICARE KENTUCKY OFFICE
3	911283	OTHER		BLOCK VISION
4	000000042390	OTHER	KY	ANTHEM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	000000062215	OTHER	IN	ANTHEM
8	K001342	OTHER		TRICARE INDIANA OFFICE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	4672263	OTHER		AETNA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194727743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES D HURT OD

Provider Business Mailing Address
First Line	:	6400 DUTCHMANS PKWY
Second Line	:	STE 125
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3342
Country	:	US
Telephone Number	:	502-896-8700
Fax Number	:	502-896-0813

Provider Business Practice Location Address
First Line	:	1169 EASTERN PKWY STE 1211
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1462
Country	:	US
Telephone Number	:	502-896-8700
Fax Number	:	502-960-8138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/13/2023

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