Healthcare Provider Details

I. General information

NPI: 1003144411
Provider Name (Legal Business Name): GEORGIA N. HARTER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CHURCH STREET
LANCASTER NY
14086
US

IV. Provider business mailing address

56 CHURCH STREET
LANCASTER NY
14086
US

V. Phone/Fax

Practice location:
  • Phone: 716-681-6722
  • Fax:
Mailing address:
  • Phone: 716-681-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001289-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number14000003279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: