Healthcare Provider Details

I. General information

NPI: 1316099641
Provider Name (Legal Business Name): DARRELL W HARDIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/16/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34950 CHARDON RD SUITE 103
WILLOUGHBY OH
44094-9162
US

IV. Provider business mailing address

34950 CHARDON RD SUITE 103
WILLOUGHBY 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 Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code229N00000X
TaxonomyAnaplastologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number25-0
License Number StateOH

VIII. Authorized Official

Name: CYNTHIA HERAK-HARDIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 216-346-8909