Provider Demographics
NPI:1427217066
Name:HARDIN EYEWEAR INC
Entity Type:Organization
Organization Name:HARDIN EYEWEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ILSE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:270-351-8660
Mailing Address - Street 1:472 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2047
Mailing Address - Country:US
Mailing Address - Phone:270-351-8660
Mailing Address - Fax:270-351-8713
Practice Address - Street 1:472 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2047
Practice Address - Country:US
Practice Address - Phone:270-351-8660
Practice Address - Fax:270-351-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY657332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0788810001Medicare NSC