Provider Demographics
NPI:1629669676
Name:HARDY, PAUL ARTHUR JR (LDO)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ARTHUR
Last Name:HARDY
Suffix:JR
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ASCHOFF CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7921
Mailing Address - Country:US
Mailing Address - Phone:864-918-0639
Mailing Address - Fax:
Practice Address - Street 1:412 ASCHOFF CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7921
Practice Address - Country:US
Practice Address - Phone:864-918-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC943332H00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier