Provider Demographics
NPI:1437167459
Name:HARDIN, TARA LYNN (OD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:HARDIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 W CAMPBELL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3469
Mailing Address - Country:US
Mailing Address - Phone:972-231-9595
Mailing Address - Fax:972-664-1629
Practice Address - Street 1:660 W CAMPBELL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3469
Practice Address - Country:US
Practice Address - Phone:972-231-9595
Practice Address - Fax:972-664-1629
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06399TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R5228OtherBCBS
TX8R5228OtherBCBS
TX8L6272Medicare PIN
V02974Medicare UPIN