MEDICARE: JEFFREY M HARTMAN 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	4712/T1501	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000122758	OTHER		ANTHEM
2	4712	OTHER		HUMANA

General Provider Information

NPI Number	:	1790894384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M HARTMAN O.D.

Provider Business Mailing Address
First Line	:	7334 YANKEE ROAD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-2803
Country	:	US
Telephone Number	:	513-759-9464
Fax Number	:	513-759-2536

Provider Business Practice Location Address
First Line	:	7334 YANKEE ROAD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-2803
Country	:	US
Telephone Number	:	513-759-9464
Fax Number	:	513-759-2536

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/09/2012

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