MEDICARE: DR. JULIE A 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
1	152W00000X	Optometrist	18003409B	IN
2	152W00000X	Optometrist	2006018277	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1689845323	OTHER	MO	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932328994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A HART O.D.

Provider Business Mailing Address
First Line	:	808 N KENTUCKY AVE
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2023
Country	:	US
Telephone Number	:	417-255-2010
Fax Number	:	417-255-2027

Provider Business Practice Location Address
First Line	:	808 N KENTUCKY AVE
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2023
Country	:	US
Telephone Number	:	417-255-2010
Fax Number	:	417-255-2027

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	09/06/2012

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