Healthcare Provider Details

I. General information

NPI: 1336411321
Provider Name (Legal Business Name): MYOPTIX FAMILY EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 VOGEL RD
EVANSVILLE IN
47715-7297
US

IV. Provider business mailing address

5700 VOGEL RD
EVANSVILLE IN
47715-7297
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-2020
  • Fax:
Mailing address:
  • Phone: 812-476-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. PAUL J. HARDESTY
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 812-476-2020