Provider Demographics
NPI:1710025697
Name:LEN D. HART, P.C.
Entity Type:Organization
Organization Name:LEN D. HART, P.C.
Other - Org Name:PRIMARY EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-371-3339
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-0640
Mailing Address - Country:US
Mailing Address - Phone:918-371-3339
Mailing Address - Fax:918-371-9600
Practice Address - Street 1:1103 W CENTER ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3108
Practice Address - Country:US
Practice Address - Phone:918-371-3339
Practice Address - Fax:918-371-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763740AMedicaid
1710025697OtherBLUE CROSS BLUE SHIELD
OKT-40486Medicare UPIN
OK100763740AMedicaid