Hertzog, James Mark
Hertzog, James Mark is an individual health care provider with primary practice located at 1004 S Pine St Ste F , Cabot AR 72023-3864. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Hertzog, James Mark can be contacted via phone (501) 941-2222.Contact Information
Primary practice address
1004 S Pine St Ste F
Cabot AR 72023-3864
Phone: (501) 941-2222
Fax: (501) 941-2577
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2584 | Arkansas |
Profile Details
| NPI number | 1124052188 |
|---|---|
| LBN Legal business name | Hertzog, James Mark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 10th, 2006 |
| Last updated | Jan 29th, 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 | 1124052188 | NPPES |
| Arkansas | Other | 499837373 | MEDICARE DMERC |
| Arkansas | MEDICAID | 167794722 | MEDICARE DMERC |
| Arkansas | Other | 49983 | MEDICARE DMERC |
| Arkansas | Other | 0215420001 | MEDICARE DMERC |
| Arkansas | Other | 882128 | MEDICARE DMERC |
| Arkansas | Other | P00450889 | MEDICARE DMERC |
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