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General NPI Number Information
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NPI Number | 1295890689
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Entity Type | Individual
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Provider Name | GARY D HAWK OD
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 02/19/2012
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Provider Practice Location Address
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Address Line | 1825 DOWNS DR
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City | ERIE
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State | PA
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Zip | 16509-7303
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Country | US
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Telephone | 814-864-8617
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Fax | 814-860-3286
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Provider Business Mailing Address
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Address Line | 318 W MAIN ST
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City | TITUSVILLE
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State | PA
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Zip | 16354-1615
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Country | US
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Telephone | 814-746-5902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OE004898P
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License Number State | PA
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