Individual
DR. STEPHANIE RENAE HARDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4830 MAIN ST, SHALLOTTE, NC 28470-1863
(910) 754-2020
(910) 754-8811
Mailing address
PO BOX 867, SHALLOTTE, NC 28459-0867
(910) 754-2020
(910) 754-8811
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2085
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909229
—
NC
01
—
NC2164A
MEDICARE PTAN
NC
Enumeration date
10/11/2006
Last updated
10/25/2011
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