Provider Demographics
NPI:1003026477
Name:GEORGE W. HERTNEKY, O.D., P.C.
Entity Type:Organization
Organization Name:GEORGE W. HERTNEKY, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:HERTNEKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-842-5166
Mailing Address - Street 1:212 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-2015
Mailing Address - Country:US
Mailing Address - Phone:970-842-5166
Mailing Address - Fax:970-842-5167
Practice Address - Street 1:212 CAMERON ST
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-2015
Practice Address - Country:US
Practice Address - Phone:970-842-5166
Practice Address - Fax:970-842-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020665Medicaid
CO04020665Medicaid