Provider Demographics
NPI:1396939542
Name:HARDEN, TED GENE II (OD)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:GENE
Last Name:HARDEN
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL DR W
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1334
Mailing Address - Country:US
Mailing Address - Phone:601-268-5910
Mailing Address - Fax:601-264-0659
Practice Address - Street 1:1223 HIGHWAY 42
Practice Address - Street 2:STE 140
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2843
Practice Address - Country:US
Practice Address - Phone:601-450-2260
Practice Address - Fax:601-450-2264
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04508001Medicaid