Provider Demographics
NPI:1477962660
Name:HADLOCK, TRENT T
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:T
Last Name:HADLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S DOBSON RD STE A206
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4743
Mailing Address - Country:US
Mailing Address - Phone:480-962-5841
Mailing Address - Fax:
Practice Address - Street 1:1450 S DOBSON RD STE A206
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4743
Practice Address - Country:US
Practice Address - Phone:480-962-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 335E00000X
AZC001110156FX1700X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No174400000XOther Service ProvidersSpecialist
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No335E00000XSuppliersProsthetic/Orthotic Supplier