Provider Demographics
NPI:1043369150
Name:RUSSELL W. HART, OD
Entity type:Organization
Organization Name:RUSSELL W. HART, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-245-9921
Mailing Address - Street 1:732 BRIERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3130
Mailing Address - Country:US
Mailing Address - Phone:785-587-8752
Mailing Address - Fax:
Practice Address - Street 1:205 S CENTENNIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-4012
Practice Address - Country:US
Practice Address - Phone:620-245-9921
Practice Address - Fax:785-539-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1396-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651142OtherBLUE CROSS BLUE SHIELD
KS651142OtherBLUE CROSS BLUE SHIELD
KSU43890Medicare UPIN