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General NPI Number Information
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NPI Number | 1043369150
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Entity Type | Organization
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Legal Business Name | RUSSELL W. HART, OD
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 205 S CENTENNIAL DR SUITE A
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City | MCPHERSON
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State | KS
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Zip | 67460-4012
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Country | US
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Telephone | 620-245-9921
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Fax | 785-539-2021
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Provider Business Mailing Address
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Address Line | 732 BRIERWOOD DR
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City | MANHATTAN
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State | KS
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Zip | 66502-3130
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Country | US
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Telephone | 785-587-8752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSELL W HART
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Credential | OD
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Telephone | 620-245-9921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1396-3
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License Number State | KS
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