MEDICARE: MICHELLE HARDIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OK2244	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124060371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HARDIN

Provider Business Mailing Address
First Line	:	902 W 13TH ST
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-3425
Country	:	US
Telephone Number	:	580-889-9500
Fax Number	:	580-889-9500

Provider Business Practice Location Address
First Line	:	902 W 13TH ST
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-3425
Country	:	US
Telephone Number	:	580-889-9500
Fax Number	:	580-889-9500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	10/28/2010

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Directions to “ MICHELLE HARDIN ” Practice Location

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