George W. Hertneky, O.D., P.C.
Organization Active NPI Optometrist · Brush, CO
NPI 1003026477 · NPPES record last updated Feb 5, 2008
Key facts
- NPI
- 1003026477
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT1893 (CO)
- Legal business name
- GEORGE W. HERTNEKY, O.D., P.C.
- Practice address
- 212 Cameron St
Brush, CO 80723-2015 - Phone
- (970) 842-5166
- Fax
- (970) 842-5167
- NPI assigned
- May 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. George Walter Hertneky, O.D.
- Title
- President
- Phone
- (970) 842-5166
Other NPIs with the same Medicare PAC ID 1
-
George Walter Hertneky, O.D.
Practitioners 1
-
George Walter Hertneky, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101129000106 | CO | Part B Supplier - Clinic/Group Practice | 4183745953 |
Receives reassigned benefits from 1 practitioner Practice locations: Brush, CO |
National Provider Directory
Locations
212 Cameron St
Brush, CO 80723
Phone (970) 842-5166
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OPT1893 | CO | Yes |
Addresses
Primary practice location
212 Cameron St
Brush, CO 80723-2015
Mailing address
212 Cameron St
Brush, CO 80723-2015
Phone (970) 842-5166
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04020665 | Medicaid | CO |
Other providers in Brush, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.