Provider Demographics
NPI:1568936680
Name:HARDIN, DARRELL W (OC)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:W
Last Name:HARDIN
Suffix:
Gender:M
Credentials:OC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34950 CHARDON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9162
Mailing Address - Country:US
Mailing Address - Phone:440-269-1166
Mailing Address - Fax:440-269-1184
Practice Address - Street 1:34950 CHARDON RD STE 103
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9162
Practice Address - Country:US
Practice Address - Phone:440-269-1166
Practice Address - Fax:440-269-1184
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
229N00000X
OHO.25156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
No229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHO.25OtherOHIO OPTICAL DISPENSERS BOARD