Provider Demographics
NPI:1982777041
Name:HART, DAVID A (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:HART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:135 GA HIGHWAY 27 E
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-5520
Mailing Address - Country:US
Mailing Address - Phone:229-928-2024
Mailing Address - Fax:229-928-2921
Practice Address - Street 1:135 GA HIGHWAY 27 E
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-5520
Practice Address - Country:US
Practice Address - Phone:229-928-2024
Practice Address - Fax:229-515-4667
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1240-T152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000467189EMedicaid
GA100906OtherAVESIS
GA326810OtherWELLCARE
GA0841310001Medicare NSC
GA511I410074Medicare UPIN
GA000467189EMedicaid