MEDICARE: RICHARD L. HARTZELL, O.D.P.C.

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	18001286A	IN

General Provider Information

NPI Number	:	1477706695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L. HARTZELL, O.D.P.C.

Provider Business Mailing Address
First Line	:	1429 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1429 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1946
Country	:	US
Telephone Number	:	317-632-9220
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD L HARTZELL
Credential	:
Telephone Number	:	317-632-9220

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	12/19/2008

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