Provider Demographics
NPI:1609592955
Name:HARDEE, DORIS LORRAINE (ABOC, NCLE, LDO)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:LORRAINE
Last Name:HARDEE
Suffix:
Gender:F
Credentials:ABOC, NCLE, LDO
Other - Prefix:MRS
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:HARDEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2110 BELLS HWY
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-6978
Mailing Address - Country:US
Mailing Address - Phone:843-539-1568
Mailing Address - Fax:
Practice Address - Street 1:2110 BELLS HWY
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-6978
Practice Address - Country:US
Practice Address - Phone:843-539-1568
Practice Address - Fax:843-539-1570
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC723156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician