Healthcare Provider Details

I. General information

NPI: 1568936680
Provider Name (Legal Business Name): DARRELL W HARDIN OC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34950 CHARDON RD STE 103
WILLOUGHBY HILLS OH
44094-9162
US

IV. Provider business mailing address

34950 CHARDON RD STE 103
WILLOUGHBY HILLS OH
44094-9162
US

V. Phone/Fax

Practice location:
  • Phone: 440-269-1166
  • Fax: 440-269-1184
Mailing address:
  • Phone: 440-269-1166
  • Fax: 440-269-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code229N00000X
TaxonomyAnaplastologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License NumberO.25
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: