Provider Demographics
NPI:1356422695
Name:DALE F. HARDY, O.D. PC
Entity type:Organization
Organization Name:DALE F. HARDY, O.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-253-1374
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057193Medicare ID - Type Unspecified
UT4125680001Medicare NSC