MEDICARE: DR. LEONARD DUANE HART 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	981	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518907765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD DUANE HART O.D.

Provider Business Mailing Address
First Line	:	1103 W CENTER ST
Second Line	:	PO BOX 640
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-3108
Country	:	US
Telephone Number	:	918-317-3339
Fax Number	:	918-371-9600

Provider Business Practice Location Address
First Line	:	1103 W CENTER ST
Second Line	:
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-3108
Country	:	US
Telephone Number	:	918-371-3339
Fax Number	:	918-371-9600

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	01/26/2013

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