Provider Demographics
NPI:1437128683
Name:HARTZELL, HOWARD R III (OD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:R
Last Name:HARTZELL
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LEADERS HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-5024
Mailing Address - Country:US
Mailing Address - Phone:717-747-5430
Mailing Address - Fax:717-747-5230
Practice Address - Street 1:309 LEADERS HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-5024
Practice Address - Country:US
Practice Address - Phone:717-747-5430
Practice Address - Fax:717-747-5230
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001116152W00000X
MDTA0952152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001269000Medicaid
PA0082845000OtherINDEPENDENCE BLUE CROSS
PA50045687OtherCAPITAL BLUE CROSS
PAPOO218215OtherRAILROAD MEDICARE
PA0012690000004Medicaid
MD1308JCOtherCAREFIRST BCBS PPO
MDT274 0003OtherCAREFIRST BCBS HMO
PAHA136628OtherHIGHMARK BLUE SHIELD
MDT274 0003OtherCAREFIRST BLUE CHOICE
PA50045687OtherKEYSTONE HPC
PAU27094Medicare UPIN
MDT274 0003OtherCAREFIRST BCBS HMO
PA0082845000OtherINDEPENDENCE BLUE CROSS
MD1308JCOtherCAREFIRST BCBS PPO
PA50045687OtherKEYSTONE HPC