Provider Demographics
NPI:1508848151
Name:HARTMANN, AMY L (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:HARTMANN
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 1:2515 CYCLONE DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9746
Mailing Address - Country:US
Mailing Address - Phone:319-433-3000
Mailing Address - Fax:319-232-1155
Practice Address - Street 1:2515 CYCLONE DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9746
Practice Address - Country:US
Practice Address - Phone:319-433-3000
Practice Address - Fax:319-232-1155
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
52819OtherBCBS OF IA
52819OtherBCBS OF IA
0140210001Medicare NSC