Healthcare Provider Details

I. General information

NPI: 1992705123
Provider Name (Legal Business Name): PAUL J HARDESTY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1484 N GREEN RIVER RD
EVANSVILLE IN
47715-2429
US

IV. Provider business mailing address

5700 VOGEL RD
EVANSVILLE IN
47715-7297
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-0623
  • Fax: 812-473-5653
Mailing address:
  • Phone: 812-476-2020
  • Fax: 812-437-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001903B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: