Hertzog Family Eye Care PA
Organization Active NPI Optometrist · Cabot, AR
NPI 1801029574 · NPPES record last updated Dec 3, 2014
Key facts
- NPI
- 1801029574
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- HERTZOG FAMILY EYE CARE PA
- Practice address
- 1004 S Pine St Ste F
Cabot, AR 72023-3864 - Phone
- (501) 941-2222
- NPI assigned
- Aug 28, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. James Hertzog, OD
- Title
- President
- Phone
- (501) 941-2222
Practitioners 5
-
James Mark Hertzog, O.D.
-
Connor Deen, OD
-
Charity Grieco Hertzog, O.D.
-
Chase Harter, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091029000087 | AR | Part B Supplier - Clinic/Group Practice | 0042357725 |
Receives reassigned benefits from 5 practitioners Practice locations: Jacksonville, AR; Cabot, AR |
National Provider Directory
Locations
1004 S Pine St
Ste F
Cabot, AR 72023
Phone (501) 941-2222
1106 S Pine St
Ste C
Cabot, AR 72023
Phone (501) 941-2222
1004 S Pine St
Cabot, AR 72023
Phone (501) 941-2222
1010 W Main St
Jacksonville, AR 72076
Phone (501) 985-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1004 S Pine St Ste F
Cabot, AR 72023-3864
Mailing address
1004 S Pine St
Suite F
Cabot, AR 72023-3865
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 179669722 | Medicaid | AR | |
| 167794722 | Medicaid | AR |
NPI Registry JSON
{
"created_epoch": "1251417600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1417564800000",
"number": "1801029574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 S PINE ST",
"address_2": "SUITE F",
"city": "CABOT",
"state": "AR",
"postal_code": "720233865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 S PINE ST STE F",
"city": "CABOT",
"state": "AR",
"postal_code": "720233864",
"telephone_number": "501-941-2222"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HERTZOG FAMILY EYE CARE PA",
"organizational_subpart": "NO",
"enumeration_date": "2009-08-28",
"last_updated": "2014-12-03",
"status": "A",
"authorized_official_last_name": "HERTZOG",
"authorized_official_first_name": "JAMES",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "501-941-2222",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "179669722",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "167794722",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cabot, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2014. 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.