Provider Demographics
NPI:1982624367
Name:HARTMAN, CHAD ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ANTHONY
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 1:8525 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2293
Mailing Address - Country:US
Mailing Address - Phone:708-599-0050
Mailing Address - Fax:708-599-1099
Practice Address - Street 1:8525 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2293
Practice Address - Country:US
Practice Address - Phone:708-599-0050
Practice Address - Fax:708-599-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009852Medicaid
IL046009852Medicaid