Provider Demographics
NPI:1699843201
Name:HARDIN, NANCY (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16425 E PALISADES BLVD
Mailing Address - Street 2:102
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3754
Mailing Address - Country:US
Mailing Address - Phone:480-837-2020
Mailing Address - Fax:480-836-9758
Practice Address - Street 1:16425 E PALISADES BLVD
Practice Address - Street 2:102
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3754
Practice Address - Country:US
Practice Address - Phone:480-837-2020
Practice Address - Fax:480-836-9758
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00985276OtherMEDICARE RAILROAD
AZP00985276OtherMEDICARE RAILROAD
AZU81938Medicare UPIN