Provider Demographics
NPI:1700883824
Name:HARTMAN, ERICK ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:ALBERT
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 1:6314 19TH ST W # 1
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6223
Mailing Address - Country:US
Mailing Address - Phone:253-566-2020
Mailing Address - Fax:253-566-3788
Practice Address - Street 1:6314 19TH ST W # 1
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:253-566-2020
Practice Address - Fax:253-566-3788
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-01-26
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
WA1362TX152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2073005Medicaid
WAGAB24728Medicare ID - Type Unspecified
WA2073005Medicaid