Provider Demographics
NPI:1720267453
Name:HART HART & ASSOCIATES OD PA
Entity type:Organization
Organization Name:HART HART & ASSOCIATES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRECTARY/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-936-2121
Mailing Address - Street 1:4600 SUMMERLIN RD STE C4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3003
Mailing Address - Country:US
Mailing Address - Phone:239-936-2121
Mailing Address - Fax:239-936-7225
Practice Address - Street 1:4600 SUMMERLIN RD STE C4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3003
Practice Address - Country:US
Practice Address - Phone:239-936-2121
Practice Address - Fax:239-936-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC00002601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086874400Medicaid
K0924Medicare PIN
FL086874400Medicaid