Provider Demographics
NPI:1447402722
Name:HART, KERRI-ANN THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:KERRI-ANN
Middle Name:THOMAS
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 1:11170 SUMMERLIN SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-5363
Mailing Address - Country:US
Mailing Address - Phone:239-985-0006
Mailing Address - Fax:
Practice Address - Street 1:11170 SUMMERLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-5363
Practice Address - Country:US
Practice Address - Phone:239-985-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist