Provider Demographics
NPI:1417054131
Name:HART, PATRICIA ANN (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
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 1:15410 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4333
Mailing Address - Country:US
Mailing Address - Phone:708-633-0011
Mailing Address - Fax:708-633-9111
Practice Address - Street 1:15410 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4333
Practice Address - Country:US
Practice Address - Phone:708-633-0011
Practice Address - Fax:708-633-9111
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL543460Medicare ID - Type Unspecified
U75197Medicare UPIN