Hartzog, Kenneth Delton
Hartzog, Kenneth Delton is an sole proprietor health care provider with primary practice located at 249 South 6Th Street , Gadsden AL 35901-4102. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Hartzog, Kenneth Delton can be contacted via phone (256) 546-4647.Contact Information
Primary practice address
249 South 6Th Street
Gadsden AL 35901-4102
Phone: (256) 546-4647
Fax: (256) 546-4272
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | S357TA046 | Alabama |
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPT000791 | Georgia |
Profile Details
| NPI number | 1710063953 |
|---|---|
| LBN Legal business name | Hartzog, Kenneth Delton |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 31st, 2006 |
| Last updated | Dec 19th, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710063953 | NPPES |
| Alabama | MEDICAID | 000059427 |
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