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DR. GEORGE WALTER HERTNEKY O.D.
>> Optometrist >> Eye and Vision Services ProvidersRegistrant NPI Number: 1053301861
Individual Registrant:DR. GEORGE WALTER HERTNEKY O.D.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
212 CAMERON ST BRUSH, CO 80723-2015 US
Tel: 970-842-5166 Fax: 970-842-5167
Tel: 970-842-5166 Fax: 970-842-5167
Contact information for business:
212 CAMERON ST BRUSH, CO 80723-2015 US
Tel: 970-842-5166 Fax: 970-842-5167
Tel: 970-842-5166 Fax: 970-842-5167
Registration Information:
NPI: 1053301861
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 152W00000X | Eye and Vision Services Providers Optometrist | CO | OPT1893 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 8018939 | CO | 05 | |
| ANTHEM BLUE CROSS BLUE SH | HE40983 | CO | 01 |
