Provider Demographics
NPI:1447275284
Name:HURST, STEFANIE A (OD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:A
Last Name:HURST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 COUNTY ROAD 42 W
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 COUNTY ROAD 42 W
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4051
Practice Address - Country:US
Practice Address - Phone:952-895-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31388OtherHEALTH PARTNERS
MN061M9FAOtherBCBS
MN407231025417OtherPREFERRED ONE
MN22-01792OtherMEDICA
MN22-01792OtherMEDICA