Provider Demographics
NPI:1194958413
Name:HARVATINE OPTOMETRY, INC.
Entity type:Organization
Organization Name:HARVATINE OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVATINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-248-8103
Mailing Address - Street 1:945 KATHRYN ST
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1644
Mailing Address - Country:US
Mailing Address - Phone:231-580-1102
Mailing Address - Fax:
Practice Address - Street 1:231 N LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1813
Practice Address - Country:US
Practice Address - Phone:717-248-8103
Practice Address - Fax:717-242-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002182261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV11049Medicare UPIN