Provider Demographics
NPI:1073661757
Name:R. E. HARDBERGER MD PA
Entity Type:Organization
Organization Name:R. E. HARDBERGER MD PA
Other - Org Name:HARDBERGER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:501-661-0450
Mailing Address - Street 1:123 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3647
Mailing Address - Country:US
Mailing Address - Phone:501-661-0450
Mailing Address - Fax:501-661-9580
Practice Address - Street 1:123 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3647
Practice Address - Country:US
Practice Address - Phone:501-661-0450
Practice Address - Fax:501-661-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2228207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5213357349Medicare NSC