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General NPI Number Information
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NPI Number | 1205025095
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Entity Type | Organization
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Legal Business Name | DAVID B. HARTIG O.D. LLC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 120 CARLYLE PLAZA DR
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City | BELLEVILLE
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State | IL
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Zip | 62221-6678
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Country | US
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Telephone | 618-236-2266
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Fax | 618-236-2288
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Provider Business Mailing Address
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Address Line | 120 CARLYLE PLAZA DR
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City | BELLEVILLE
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State | IL
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Zip | 62221-6678
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Country | US
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Telephone | 618-236-2266
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Fax | 618-236-2288
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DAVID B HARTIG
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Credential | O.D.
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Telephone | 618-236-2266
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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 |
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License Number State | IL
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