MEDICARE: MR. MARK T HUNT 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	152W00000X	Optometrist	361	NV
2	152W00000X	Optometrist	375881-9934	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457334740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK T HUNT OD

Provider Business Mailing Address
First Line	:	161 W 200 N
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770
Country	:	US
Telephone Number	:	435-668-3840
Fax Number	:	435-652-1516

Provider Business Practice Location Address
First Line	:	2650 E CRAIG ROAD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89030
Country	:	US
Telephone Number	:	435-668-3840
Fax Number	:	435-652-1516

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	03/02/2018

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