Provider Demographics
NPI:1659533578
Name:RONALD DOUGLAS HARDAWAY HARDAWAY'S ECONOMY OPTICAL
Entity Type:Organization
Organization Name:RONALD DOUGLAS HARDAWAY HARDAWAY'S ECONOMY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HARDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:432-570-6900
Mailing Address - Street 1:2211 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6421
Mailing Address - Country:US
Mailing Address - Phone:432-570-6900
Mailing Address - Fax:432-570-6805
Practice Address - Street 1:2211 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6421
Practice Address - Country:US
Practice Address - Phone:432-570-6900
Practice Address - Fax:432-570-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0144332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1201940001Medicare NSC