Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 0601001706 | VA |
Y | 152W00000X | Optometrist | OE-007169-T | PA |
NPI | 1013003474 |
---|---|
Provider Name | Dr. Robert Joseph Hartsock JR. |
First Address | Pittsburgh, PA 15237-2331 |
Second Address | Pittsburgh, PA 15205-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01798635 | (05) | PA |
397125 | NATIONAL VISION ADMINISTR (01) | PA |
696201HA | BLUE CROSS/BLUE SHIELD (01) | PA |
U31501 | (02) | PA |