Provider Demographics
NPI:1831482603
Name:HERTZOG, CHARITY GRIECO (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:GRIECO
Last Name:HERTZOG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10809 EXECUTIVE CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-6021
Mailing Address - Country:US
Mailing Address - Phone:501-588-0072
Mailing Address - Fax:501-221-3751
Practice Address - Street 1:10809 EXECUTIVE CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-6021
Practice Address - Country:US
Practice Address - Phone:501-588-0072
Practice Address - Fax:501-221-3751
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist