Healthcare Provider Details

I. General information

NPI: 1326230657
Provider Name (Legal Business Name): ANTHONY KENT HARTNESS O. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 SMILES AVE
AUGUSTA KS
67010-2385
US

IV. Provider business mailing address

1851 N WEBB RD ATTN - FLR2
WICHITA KS
67206-3413
US

V. Phone/Fax

Practice location:
  • Phone: 316-775-6155
  • Fax: 316-775-0296
Mailing address:
  • Phone: 316-636-2010
  • Fax: 316-858-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1775
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: