MEDICARE: DR. CAROLINE HART 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	TA1940	MD

General Provider Information

NPI Number	:	1538151907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE HART O.D.

Provider Business Mailing Address
First Line	:	14742 GROBIE POND LN
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-2989
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8875 A CENTRE PARK DR
Second Line	:	CENTREPARK EYECARE
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2382
Country	:	US
Telephone Number	:	410-884-5508
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/31/2013

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