Provider Demographics
NPI:1598987646
Name:DAVID L HARTZELL MD
Entity Type:Organization
Organization Name:DAVID L HARTZELL MD
Other - Org Name:HARTZELL EYE MDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:HARTZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-243-8606
Mailing Address - Street 1:37 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015
Mailing Address - Country:US
Mailing Address - Phone:717-243-8606
Mailing Address - Fax:717-243-7221
Practice Address - Street 1:37 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9126
Practice Address - Country:US
Practice Address - Phone:717-243-8606
Practice Address - Fax:717-243-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010154E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02534900OtherCAPITAL BLUE CROSS
PA1007660680003Medicaid
PA02534900OtherCAPITAL BLUE CROSS