Provider Demographics
NPI:1891893095
Name:CRAIG P HARTNAGEL O.D. P.C.
Entity Type:Organization
Organization Name:CRAIG P HARTNAGEL O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARTNAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-488-2700
Mailing Address - Street 1:1676 FOOTE AVE. EXT.
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701
Mailing Address - Country:US
Mailing Address - Phone:716-488-2700
Mailing Address - Fax:716-488-2702
Practice Address - Street 1:1676 FOOTE AVE. EXT.
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-488-2700
Practice Address - Fax:716-488-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02503840Medicaid
NYU63473Medicare UPIN
NY56991AMedicare ID - Type Unspecified