Provider Demographics
NPI:1699855486
Name:HART, DEAN E (OD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:E
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 1:185 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3029
Mailing Address - Country:US
Mailing Address - Phone:516-681-3937
Mailing Address - Fax:516-681-1272
Practice Address - Street 1:185 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3029
Practice Address - Country:US
Practice Address - Phone:516-681-3937
Practice Address - Fax:516-681-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004847-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400045110Medicare PIN
NYC33951Medicare ID - Type Unspecified
NYT71151Medicare UPIN