MEDICARE: BRUCE HYATT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TAO749MD	MD

General Provider Information

NPI Number	:	1760672729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE HYATT

Provider Business Mailing Address
First Line	:	409 W COLD SPRING LN
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21210-2845
Country	:	US
Telephone Number	:	410-243-8884
Fax Number	:	410-243-5656

Provider Business Practice Location Address
First Line	:	409 W COLD SPRING LN
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21210-2845
Country	:	US
Telephone Number	:	410-243-8884
Fax Number	:	410-243-5656

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. BRUCE IRVIN HYATT
Credential	:	O.D.
Telephone Number	:	410-243-8884

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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