Provider Demographics
NPI:1902807076
Name:HART, PEGGY (OD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14032B MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6844
Mailing Address - Country:US
Mailing Address - Phone:281-436-1635
Mailing Address - Fax:281-496-6016
Practice Address - Street 1:14032B MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6844
Practice Address - Country:US
Practice Address - Phone:281-436-1635
Practice Address - Fax:281-496-6016
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3476TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0772Medicare UPIN