Provider Demographics
NPI:1518907765
Name:HART, LEONARD DUANE (OD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:DUANE
Last Name:HART
Suffix:
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 1:1103 W CENTER ST
Mailing Address - Street 2:PO BOX 640
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-3108
Mailing Address - Country:US
Mailing Address - Phone:918-317-3339
Mailing Address - Fax:918-371-9600
Practice Address - Street 1:1103 W CENTER ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3108
Practice Address - Country:US
Practice Address - Phone:918-371-3339
Practice Address - Fax:918-371-9600
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763740AMedicaid
OK100763740AMedicaid
OK$$$$$$$$$Medicare PIN