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NPI Code Detail

MEDICARE: JEFFREY M HARTMAN O.D.

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
1152W00000XOptometrist4712/T1501OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000122758OTHERANTHEM
24712OTHERHUMANA

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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