Provider Demographics
NPI:1528126562
Name:HARTWELL, JAY A (OD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:HARTWELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1643 JULIE LN
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3577
Mailing Address - Country:US
Mailing Address - Phone:208-734-6410
Mailing Address - Fax:208-733-4635
Practice Address - Street 1:1543 POLELINE RD E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3590
Practice Address - Country:US
Practice Address - Phone:208-733-1157
Practice Address - Fax:208-733-4635
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDODP-517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist