Provider Demographics
NPI:1326230657
Name:HARTNESS, ANTHONY KENT (O D)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:KENT
Last Name:HARTNESS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 N WEBB RD
Mailing Address - Street 2:ATTN - FLR2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-636-2010
Mailing Address - Fax:316-858-3830
Practice Address - Street 1:706 SMILES AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2385
Practice Address - Country:US
Practice Address - Phone:316-775-6155
Practice Address - Fax:316-775-0296
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200518180AMedicaid
KSCD2825OtherRAILROAD MEDICARE GROUP NUMBER
KSP00466505OtherRAILROAD MEDICARE PTAN
KSP00466505OtherRAILROAD MEDICARE PTAN