Provider Demographics
NPI:1790894384
Name:HARTMAN, JEFFREY M (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:HARTMAN
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 1:7334 YANKEE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-2803
Mailing Address - Country:US
Mailing Address - Phone:513-759-9464
Mailing Address - Fax:513-759-2536
Practice Address - Street 1:7334 YANKEE ROAD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-2803
Practice Address - Country:US
Practice Address - Phone:513-759-9464
Practice Address - Fax:513-759-2536
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4712/T1501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000122758OtherANTHEM
4712OtherHUMANA
000000122758OtherANTHEM
U66274Medicare UPIN