Provider Demographics
NPI:1356326607
Name:HEARN, PAUL BRADFORD (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRADFORD
Last Name:HEARN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16525 BIRKDALE COMMONS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3802
Mailing Address - Country:US
Mailing Address - Phone:704-896-3311
Mailing Address - Fax:704-896-5514
Practice Address - Street 1:16525 BIRKDALE COMMONS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3802
Practice Address - Country:US
Practice Address - Phone:704-896-3311
Practice Address - Fax:704-896-5514
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909402Medicaid
NC0916HOtherBLUE CROSS BLUE SHIELD
NC246581BMedicare ID - Type Unspecified
NC8909402Medicaid