MEDICARE: DR. DEAN L HARTWIG O. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2367-35	WI
2	152W00000X	Optometrist	4901003320	MI

General Provider Information

NPI Number	:	1457355067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN L HARTWIG O. D.

Provider Business Mailing Address
First Line	:	325 E H ST
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-4760
Country	:	US
Telephone Number	:	906-774-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 E H ST
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801
Country	:	US
Telephone Number	:	906-774-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	12/07/2018

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