Provider Demographics
NPI:1417125485
Name:DANNY L. HARTZOG OD PC
Entity Type:Organization
Organization Name:DANNY L. HARTZOG OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARTZOG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-775-3295
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:AL
Mailing Address - Zip Code:36016-0519
Mailing Address - Country:US
Mailing Address - Phone:334-775-3295
Mailing Address - Fax:334-775-8269
Practice Address - Street 1:6 EAST COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:AL
Practice Address - Zip Code:36016-5106
Practice Address - Country:US
Practice Address - Phone:334-775-3295
Practice Address - Fax:334-775-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS377TA045332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51059440OtherBLUE CROSS BLUE SHIELD
ALT68933Medicare UPIN
AL0330350001Medicare NSC