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General NPI Number Information
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NPI Number | 1417125485
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Entity Type | Organization
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Legal Business Name | DANNY L. HARTZOG OD PC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 6 EAST COLLEGE AVE
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City | CLAYTON
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State | AL
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Zip | 36016-5106
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Country | US
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Telephone | 334-775-3295
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Fax | 334-775-8269
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Provider Business Mailing Address
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Address Line | PO BOX 519
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City | CLAYTON
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State | AL
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Zip | 36016-0519
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Country | US
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Telephone | 334-775-3295
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Fax | 334-775-8269
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANNY L HARTZOG
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Credential | O.D.
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Telephone | 334-775-3295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | S377TA045
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License Number State | AL
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