Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | O.25 | OH |
NPI | 1568936680 |
---|---|
Provider Name | Mr. Darrell W Hardin |
First Address | Willoughby Hills, OH 44094-9162 |
Second Address | Willoughby Hills, OH 44094-9162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2019 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
O.25 | OHIO OPTICAL DISPENSERS BOARD (01) | OH |