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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK208152W00000X
GA906152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD2760Medicaid
AK41ZCDZBMedicare ID - Type Unspecified
AKOD2760Medicaid