Provider Demographics
NPI:1326318890
Name:MA RM JH INC
Entity Type:Organization
Organization Name:MA RM JH INC
Other - Org Name:HARDWICK VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-997-7766
Mailing Address - Street 1:1502 E BROAD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4908
Mailing Address - Country:US
Mailing Address - Phone:910-997-7766
Mailing Address - Fax:
Practice Address - Street 1:1502 E BROAD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4908
Practice Address - Country:US
Practice Address - Phone:910-997-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC829156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920956Medicaid
NC5428A916Medicare PIN