Provider Demographics
NPI:1194777300
Name:HART OPHTHALMOLOGY ASSOCIATES, P.S.C.
Entity type:Organization
Organization Name:HART OPHTHALMOLOGY ASSOCIATES, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-753-3131
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 505E
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-753-3131
Mailing Address - Fax:270-753-3169
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 505E
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-753-3131
Practice Address - Fax:270-753-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65926800Medicaid
KY18D0325658OtherCLIA
KYCF7870OtherRAILROAD MEDICARE
KY000000059042OtherANTHEM
KYCF7870OtherRAILROAD MEDICARE
KY65926800Medicaid