Provider Demographics
NPI:1093808362
Name:HARDY, JOHN CALVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CALVIN
Last Name:HARDY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 BEAVER LDG
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8683
Mailing Address - Country:US
Mailing Address - Phone:970-243-1138
Mailing Address - Fax:
Practice Address - Street 1:2881 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-5064
Practice Address - Country:US
Practice Address - Phone:970-241-0943
Practice Address - Fax:970-241-0215
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 2453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist