Healthcare Provider Details

I. General information

NPI: 1720267453
Provider Name (Legal Business Name): HART HART & ASSOCIATES OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SUMMERLIN RD STE C4
FORT MYERS FL
33919-3003
US

IV. Provider business mailing address

4600 SUMMERLIN RD STE C4
FORT MYERS FL
33919-3003
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-2121
  • Fax: 239-936-7225
Mailing address:
  • Phone: 239-936-2121
  • Fax: 239-936-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC00002601
License Number StateFL

VIII. Authorized Official

Name: DR. BRENDA HART
Title or Position: SECRECTARY/OPTOMETRIST
Credential: O.D.
Phone: 239-936-2121