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NPI Code Detail

MEDICARE: DR. RUSSELL W HART O.D.

MEDICARE: DR. RUSSELL W 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
1152W00000XOptometrist1396-3KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1651142OTHERKSBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851386379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL W HART O.D.
Provider Business Mailing Address
First Line : 650 HUEBNER RD
Second Line :
City : FORT RILEY
State : KS
Zip : 66442-4030
Country : US
Telephone Number : 785-240-5517
Fax Number :
Provider Business Practice Location Address
First Line : 8072 NORMANDY DR
Second Line :
City : FORT RILEY
State : KS
Zip : 66442-7069
Country : US
Telephone Number : 785-240-5516
Fax Number : 785-239-4065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 08/16/2022

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