Provider Demographics
NPI:1679557037
Name:HARTUNG, LARRY T (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:T
Last Name:HARTUNG
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 1:55 OAK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1950
Mailing Address - Country:US
Mailing Address - Phone:508-255-0480
Mailing Address - Fax:508-240-0109
Practice Address - Street 1:55 OAK RD
Practice Address - Street 2:
Practice Address - City:NORTH EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02651-1950
Practice Address - Country:US
Practice Address - Phone:508-255-0480
Practice Address - Fax:508-240-0109
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOP2981TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0349402Medicaid
MA217158Medicare ID - Type Unspecified
MAT59365Medicare UPIN