MEDICARE: DR. JAY A. HARTWELL O.D.

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	ODP-517	ID

General Provider Information

NPI Number	:	1528126562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY A. HARTWELL O.D.

Provider Business Mailing Address
First Line	:	3435 MOONLIGHT DR
Second Line	:
City	:	KIMBERLY
State	:	ID
Zip	:	83341-4008
Country	:	US
Telephone Number	:	833-776-2020
Fax Number	:	208-297-7519

Provider Business Practice Location Address
First Line	:	1605 BLUE LAKES BLVD N STE A
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-3322
Country	:	US
Telephone Number	:	833-776-2020
Fax Number	:	208-297-7519

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/10/2026

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