Provider Demographics
NPI:1114928694
Name:HARTKORN, PAUL F (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:HARTKORN
Suffix:
Gender:M
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:PO BOX 2117
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-2117
Mailing Address - Country:US
Mailing Address - Phone:509-826-0240
Mailing Address - Fax:
Practice Address - Street 1:19 W CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-826-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1230TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1002801Medicaid
WA1002801Medicaid
WAT02306Medicare UPIN
3407360001Medicare NSC