Healthcare Provider Details

I. General information

NPI: 1285568725
Provider Name (Legal Business Name): HARSHAL MEHTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BRIARCREST SQ
HERSHEY PA
17033-2359
US

IV. Provider business mailing address

111 E 4TH ST STE 440
ALTON IL
62002-6206
US

V. Phone/Fax

Practice location:
  • Phone: 717-533-2362
  • Fax:
Mailing address:
  • Phone: 618-462-9818
  • Fax: 314-741-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004370
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: