Provider Demographics
NPI:1710087184
Name:HARTENSTEIN, DAVID M (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:HARTENSTEIN
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 1:760 LAFAYETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842
Mailing Address - Country:US
Mailing Address - Phone:603-926-5471
Mailing Address - Fax:603-926-9546
Practice Address - Street 1:760 LAFAYETTE ROAD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842
Practice Address - Country:US
Practice Address - Phone:603-926-5471
Practice Address - Fax:603-926-9546
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0906080Y0NH01OtherANTHEM
NH80582293Medicaid
NHNH2293Medicare ID - Type Unspecified
NH80582293Medicaid