Healthcare Provider Details

I. General information

NPI: 1871580548
Provider Name (Legal Business Name): DENNIS WAYNE HEDRICK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 GREENBRIER ST
CHARLESTON WV
25311-1527
US

IV. Provider business mailing address

806 GREENBRIER ST
CHARLESTON WV
25311-1527
US

V. Phone/Fax

Practice location:
  • Phone: 304-342-5900
  • Fax: 304-342-6257
Mailing address:
  • Phone: 304-342-5900
  • Fax: 304-342-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number870-OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: