Provider Demographics
NPI:1437280468
Name:HART, DAN (OD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:HART
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:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-1522
Mailing Address - Country:US
Mailing Address - Phone:907-766-3682
Mailing Address - Fax:907-766-3682
Practice Address - Street 1:1000 S SEWARD MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7506
Practice Address - Country:US
Practice Address - Phone:907-357-7620
Practice Address - Fax:907-357-7621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK208152W00000X
GA906152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD2760Medicaid
AK41ZCDZBMedicare ID - Type Unspecified
AKOD2760Medicaid