Provider Demographics
NPI:1992705123
Name:HARDESTY, PAUL J (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:HARDESTY
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 1:5700 VOGEL RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7297
Mailing Address - Country:US
Mailing Address - Phone:812-476-2020
Mailing Address - Fax:812-437-9488
Practice Address - Street 1:1484 N GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2429
Practice Address - Country:US
Practice Address - Phone:812-477-0623
Practice Address - Fax:812-473-5653
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001903B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN567611OtherHIGHMARK
IN10112OtherSPECTERA
IN000000085302OtherANTHEM
IN100101210AMedicaid
IN410033702OtherRR MEDICARE
ININ1903OtherEYEMED
IN000000085302OtherANTHEM
ININ1903OtherEYEMED