Provider Demographics
NPI:1558374090
Name:HARTZOK, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:HARTZOK
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 1:71 BRUMBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2803
Mailing Address - Country:US
Mailing Address - Phone:717-264-7225
Mailing Address - Fax:717-264-8637
Practice Address - Street 1:71 BRUMBAUGH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2803
Practice Address - Country:US
Practice Address - Phone:717-264-7225
Practice Address - Fax:717-264-8637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29690Medicare UPIN
PA0774290001Medicare NSC
PA152587Medicare ID - Type Unspecified