Provider Demographics
NPI:1144270166
Name:HARTMAN, RICKEY L (OD)
Entity type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:L
Last Name:HARTMAN
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 1:1340 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2617
Mailing Address - Country:US
Mailing Address - Phone:919-552-3181
Mailing Address - Fax:919-552-0197
Practice Address - Street 1:1340 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2617
Practice Address - Country:US
Practice Address - Phone:919-552-3181
Practice Address - Fax:919-552-0197
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909359Medicaid
NC8909405Medicaid
NC09359OtherBCBS GARNER
NCC10278OtherRR MEDICARE
NC09405OtherBCBS FUQUAY
NCDE1984OtherRR MEDICARE
NC410034730OtherRR MEDICARE
NC2701064OtherAETNA
NC4493993OtherAETNA
NC580000125OtherRR MEDICARE
NC246343Medicare ID - Type UnspecifiedGARNER OFFICE
NC410034730OtherRR MEDICARE
NC2701064OtherAETNA
NC0225540003Medicare NSC
NC580000125OtherRR MEDICARE