Provider Demographics
NPI:1063515252
Name:HARTIG, MARC S (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:HARTIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3625
Mailing Address - Country:US
Mailing Address - Phone:614-801-2020
Mailing Address - Fax:614-801-0001
Practice Address - Street 1:4140 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3625
Practice Address - Country:US
Practice Address - Phone:614-801-2020
Practice Address - Fax:614-801-0001
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA0792465Medicare ID - Type UnspecifiedPROVIDER NUMBER
OHU60222Medicare UPIN