Provider Demographics
NPI:1346411196
Name:DR LARRY HARTUNG
Entity Type:Organization
Organization Name:DR LARRY HARTUNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-255-0480
Mailing Address - Street 1:55 OAK RD
Mailing Address - Street 2:
Mailing Address - City:N EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1950
Mailing Address - Country:US
Mailing Address - Phone:508-255-0480
Mailing Address - Fax:
Practice Address - Street 1:55 OAK RD
Practice Address - Street 2:
Practice Address - City:N EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02651-1950
Practice Address - Country:US
Practice Address - Phone:508-255-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0349402Medicaid
MA217158Medicare PIN
MA0349402Medicaid