1093955965 NPI number — MARK H. HARDER OD

Table of content: (NPI 1093955965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093955965 NPI number — MARK H. HARDER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK H. HARDER OD
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:
MARK HARDER OPTOMETRY
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:
1093955965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 E ORANGEBURG AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95350-5578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-596-4360
Provider Business Mailing Address Fax Number:
209-566-0685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E ORANGEBURG AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350-5578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-596-4360
Provider Business Practice Location Address Fax Number:
209-566-0685
Provider Enumeration Date:
03/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARDER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
209-596-4360

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  CA07481T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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