MEDICARE: DR. MARK A HARDACRE O.D.

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	2471	CO

General Provider Information

NPI Number	:	1972792562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A HARDACRE O.D.

Provider Business Mailing Address
First Line	:	10821 CHAMBERS WAY
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9596
Country	:	US
Telephone Number	:	303-953-0110
Fax Number	:	303-953-0110

Provider Business Practice Location Address
First Line	:	10821 CHAMBERS WAY
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9596
Country	:	US
Telephone Number	:	303-953-0110
Fax Number	:	303-953-0110

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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