Hardison, Jerry Samuel
Hardison, Jerry Samuel is an individual health care provider with primary practice located at 553 Farmington Ave , Hartford CT 06105-3048. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Hardison, Jerry Samuel can be contacted via phone (860) 236-5831.Contact Information
Primary practice address
553 Farmington Ave
Hartford CT 06105-3048
Phone: (860) 236-5831
Fax: (860) 236-2966
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 851 | Connecticut |
Profile Details
| NPI number | 1306841077 |
|---|---|
| LBN Legal business name | Hardison, Jerry Samuel |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 17th, 2005 |
| Last updated | Feb 8th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306841077 | NPPES |
| Connecticut | MEDICAID | 4024659 |
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