Provider Demographics
NPI:1184611337
Name:HARDY, CYNTHIA ANN (OD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:HARDY
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 1:2533 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5873
Mailing Address - Country:US
Mailing Address - Phone:954-922-6480
Mailing Address - Fax:
Practice Address - Street 1:2161 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3810
Practice Address - Country:US
Practice Address - Phone:954-771-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620537200Medicaid
FL620537200Medicaid
FLE4774ZMedicare PIN
FLE4774XMedicare PIN
FLE4774AMedicare PIN