Provider Demographics
NPI:1164760773
Name:HYATT, RUTH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:HYATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 HAND AVE
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1139
Mailing Address - Country:US
Mailing Address - Phone:386-673-3939
Mailing Address - Fax:
Practice Address - Street 1:1545 HAND AVE
Practice Address - Street 2:SUITE B-3
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1139
Practice Address - Country:US
Practice Address - Phone:386-673-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist