Provider Demographics
NPI:1376516948
Name:HARTNAGEL, CRAIG P (OD , PC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:P
Last Name:HARTNAGEL
Suffix:
Gender:M
Credentials:OD , PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 FOOTE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9385
Mailing Address - Country:US
Mailing Address - Phone:716-488-2700
Mailing Address - Fax:716-488-2702
Practice Address - Street 1:1676 FOOTE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9385
Practice Address - Country:US
Practice Address - Phone:716-488-2700
Practice Address - Fax:716-488-2702
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02503840Medicaid
NYU63473Medicare UPIN
NY56991AMedicare PIN