Provider Demographics
NPI:1003918442
Name:HART, BRENDA CATINEAU (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:CATINEAU
Last Name:HART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 STRATHMORE LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4693
Mailing Address - Country:US
Mailing Address - Phone:239-561-0679
Mailing Address - Fax:239-936-7225
Practice Address - Street 1:14290 METROPOLIS AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-561-0679
Practice Address - Fax:888-972-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086874400Medicaid
FL086874400Medicaid
FL20418WMedicare ID - Type Unspecified