Basic Information
| Provider Information | |||||||||
| NPI: | 1437167459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDIN | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 W CAMPBELL RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750803469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722319595 | ||||||||
| FaxNumber: | 9726641629 | ||||||||
| Practice Location | |||||||||
| Address1: | 660 W CAMPBELL RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750803469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722319595 | ||||||||
| FaxNumber: | 9726641629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 06399TG | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 8R5228 | 01 | TX | BCBS | OTHER |