=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720267453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HART HART & ASSOCIATES OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 SUMMERLIN RD STE C4
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33919-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-936-2121
-----------------------------------------------------
Fax | 239-936-7225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4600 SUMMERLIN RD STE C4
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33919-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-936-2121
-----------------------------------------------------
Fax | 239-936-7225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRECTARY/OPTOMETRIST
-----------------------------------------------------
Name | DR. BRENDA HART
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 239-936-2121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC00002601
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------