Provider Demographics
NPI:1548482144
Name:J. FERRELL HARTIN, OD, PC
Entity type:Organization
Organization Name:J. FERRELL HARTIN, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EYE CARE DIRECTOR AND PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FERRELL
Authorized Official - Last Name:HARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-499-5104
Mailing Address - Street 1:14802 TURKEY TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4511
Mailing Address - Country:US
Mailing Address - Phone:210-865-0202
Mailing Address - Fax:
Practice Address - Street 1:5300 SAN DARIO AVE
Practice Address - Street 2:MALL DEL NORTE, SEARS
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3000
Practice Address - Country:US
Practice Address - Phone:210-865-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1764T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T40487Medicare UPIN