Provider Demographics
NPI:1902977556
Name:HARDAWAY, RONALD DOUGLAS (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DOUGLAS
Last Name:HARDAWAY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6421
Mailing Address - Country:US
Mailing Address - Phone:432-570-6900
Mailing Address - Fax:432-570-6805
Practice Address - Street 1:2211 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6421
Practice Address - Country:US
Practice Address - Phone:432-570-6900
Practice Address - Fax:432-570-6805
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0144156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1201940001Medicare NSC