Individual
DR. JAMES MARK HERTZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1004 S PINE ST STE F, CABOT, AR 72023-3864
(501) 941-2222
(501) 941-2577
Mailing address
1004 S PINE ST STE F, CABOT, AR 72023-3864
(501) 941-2222
(501) 941-2577
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2584
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215420001
MEDICARE DMERC REGION C
AR
05
—
167794722
—
AR
01
—
49983
MEDICARE DMERC
AR
01
—
499837373
MEDICARE DMERC
AR
01
—
882128
HEALTHLINKPPO
AR
01
—
P00450889
RAIL ROAD MEDICARE
AR
Enumeration date
07/10/2006
Last updated
01/29/2013
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