Healthcare Provider Details

I. General information

NPI: 1407100548
Provider Name (Legal Business Name): HYDE YOUR EYES OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2012
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2193 BROADWAY
NEW YORK NY
10024-6664
US

IV. Provider business mailing address

2193 BROADWAY
NEW YORK NY
10024-6664
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-2980
  • Fax: 212-877-0549
Mailing address:
  • Phone: 212-877-2980
  • Fax: 212-877-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number005055
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID G HYDE
Title or Position: PRESIDENT
Credential: O.D
Phone: 212-877-2980