Provider Demographics
NPI:1356343487
Name:HARDY, DALE F (OD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:F
Last Name:HARDY
Suffix:
Gender:M
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:PO BOX 95110
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0110
Mailing Address - Country:US
Mailing Address - Phone:801-253-1374
Mailing Address - Fax:801-253-1672
Practice Address - Street 1:10372 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9339
Practice Address - Country:US
Practice Address - Phone:801-253-1374
Practice Address - Fax:801-253-1672
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1101029934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005719301Medicare ID - Type Unspecified
UTT95883Medicare UPIN