Provider Demographics
NPI:1679525968
Name:HARTWELL, RICHARD ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALEXANDER
Last Name:HARTWELL
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 1:110 CHARLTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1538
Mailing Address - Country:US
Mailing Address - Phone:508-347-3300
Mailing Address - Fax:508-347-6303
Practice Address - Street 1:110 CHARLTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1538
Practice Address - Country:US
Practice Address - Phone:508-347-3300
Practice Address - Fax:508-347-6303
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17464Medicare ID - Type Unspecified
U74412Medicare UPIN