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General NPI Number Information
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NPI Number | 1093787459
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Entity Type | Individual
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Provider Name | MARK HENRY HARDER OD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 501 E ORANGEBURG AVE STE B
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City | MODESTO
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State | CA
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Zip | 95350
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Country | US
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Telephone | 209-596-4360
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Fax | 209-566-0685
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Provider Business Mailing Address
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Address Line | 501 E ORANGEBURG AVE STE B
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City | MODESTO
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State | CA
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Zip | 95350-5578
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Country | US
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Telephone | 209-596-4360
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Fax | 209-566-0685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | CA07481T
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License Number State | CA
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