MEDICARE: HARTZELL EYE SPECIALISTS, LLC

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	207W00000X	Ophthalmology Physician	MD065978L	PA

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	:	1861761512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARTZELL EYE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	37 BROOKWOOD AVE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015-9126
Country	:	US
Telephone Number	:	717-243-8606
Fax Number	:	717-243-7221

Provider Business Practice Location Address
First Line	:	37 BROOKWOOD AVE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015-9126
Country	:	US
Telephone Number	:	717-243-8606
Fax Number	:	717-243-7221

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DAVID LEIGH HARTZELL
Credential	:	M.D.
Telephone Number	:	717-243-7221

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	05/10/2012

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