Healthcare Provider Details

I. General information

NPI: 1922078294
Provider Name (Legal Business Name): DENNIS WHITTIER HARTMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COLLINS DR
MERCED CA
95348-3121
US

IV. Provider business mailing address

580 COLLINS DR
MERCED CA
95348-3121
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-0989
  • Fax: 209-383-6836
Mailing address:
  • Phone: 209-383-0989
  • Fax: 209-383-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9253T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: