1356422695 NPI number — DALE F. HARDY, O.D. PC

Table of content: (NPI 1356422695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356422695 NPI number — DALE F. HARDY, O.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALE F. HARDY, O.D. PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VISION SOURCE-SOUTH VALLEY EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356422695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-0110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-253-1374
Provider Business Mailing Address Fax Number:
801-253-1672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10372 S REDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84095-9339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-253-1374
Provider Business Practice Location Address Fax Number:
801-253-1672
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARDY
Authorized Official First Name:
DALE
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-253-1374

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)