Provider Demographics
NPI:1265623706
Name:HARDY, RAYMOND F (OD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:F
Last Name:HARDY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 NE 3RD ST
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3106
Mailing Address - Country:US
Mailing Address - Phone:541-382-0103
Mailing Address - Fax:541-385-6851
Practice Address - Street 1:1250 NE 3RD ST
Practice Address - Street 2:SUITE B-100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3106
Practice Address - Country:US
Practice Address - Phone:541-382-0103
Practice Address - Fax:541-385-6851
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3224AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist