Provider Demographics
NPI:1912083452
Name:HIRT, STEPHEN GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GEORGE
Last Name:HIRT
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 1:487 LAZELLE RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9540
Mailing Address - Country:US
Mailing Address - Phone:614-431-2099
Mailing Address - Fax:614-431-2011
Practice Address - Street 1:487 LAZELLE RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-9540
Practice Address - Country:US
Practice Address - Phone:614-431-2099
Practice Address - Fax:614-431-2011
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2604855Medicaid
OHU52711Medicare UPIN
OH4298811Medicare PIN