Thomas William Hurst, OD
Individual provider Active NPI Optometrist · Bloomfield, NM
NPI 1699766287 · NPPES record last updated Feb 1, 2008
Key facts
- NPI
- 1699766287
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 000369 (AL)
- Practice address
- 6 Road 7586
Bloomfield, NM 87413-4934 - Phone
- (505) 368-6401
- Fax
- (505) 368-6431
- NPI assigned
- Nov 2, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000369 | AL | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 000369 | AL | Yes |
Addresses
Primary practice location
6 Road 7586
Bloomfield, NM 87413-4934
Mailing address
PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01071262 | Medicaid | CO | |
| 78126 | Medicaid | NM | |
| 432401 | Medicaid | AZ |
Other providers in Bloomfield, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.