Provider Demographics
NPI:1487760591
Name:HURWITZ, STEPHEN (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:HURWITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TILLER RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-9674
Mailing Address - Country:US
Mailing Address - Phone:570-371-9558
Mailing Address - Fax:570-424-8751
Practice Address - Street 1:18 TILLER RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-9674
Practice Address - Country:US
Practice Address - Phone:570-371-9558
Practice Address - Fax:570-424-8751
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA185452Q1AMedicare UPIN