Provider Demographics
NPI:1922258375
Name:HARTMAN, AARON MAX (OD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:MAX
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 1:751 W HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2427
Mailing Address - Country:US
Mailing Address - Phone:801-886-2020
Mailing Address - Fax:801-954-0054
Practice Address - Street 1:5421 S 19TH W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067
Practice Address - Country:US
Practice Address - Phone:801-825-9703
Practice Address - Fax:801-825-5349
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7059136-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000009923OtherMEDICARE PTAN STORE #15
UT1396832655Medicaid
UT1780785238Medicaid
UT000009430OtherMEDICARE STORE #9 PTAN
UTU000009923OtherMEDICARE PTAN STORE #15
UT1396832655Medicaid
UT1780785238Medicaid
UT000066413Medicare PIN