MEDICARE: HART HART & ASSOCIATES OD PA

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	OPC00002601	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720267453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HART HART & ASSOCIATES OD PA

Provider Business Mailing Address
First Line	:	4600 SUMMERLIN RD STE C4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3003
Country	:	US
Telephone Number	:	239-936-2121
Fax Number	:	239-936-7225

Provider Business Practice Location Address
First Line	:	4600 SUMMERLIN RD STE C4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3003
Country	:	US
Telephone Number	:	239-936-2121
Fax Number	:	239-936-7225

Authorized Official
Title or Position	:	SECRECTARY/OPTOMETRIST
Name	:	DR. BRENDA HART
Credential	:	O.D.
Telephone Number	:	239-936-2121

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	07/08/2008

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