Provider Demographics
NPI:1629052527
Name:HARTMAN, CARL T (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:T
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3300 E SOUTH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4579
Mailing Address - Country:US
Mailing Address - Phone:562-531-2020
Mailing Address - Fax:562-531-1142
Practice Address - Street 1:3300 EAST SOUTH STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-531-2020
Practice Address - Fax:562-531-1142
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG60568174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF08301Medicare UPIN