Provider Demographics
NPI:1174505853
Name:HURD, SHAYE S (OD)
Entity Type:Individual
Prefix:
First Name:SHAYE
Middle Name:S
Last Name:HURD
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 1:7801 RIVERS AVE
Mailing Address - Street 2:SEARS BUILDING
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4015
Mailing Address - Country:US
Mailing Address - Phone:843-572-6622
Mailing Address - Fax:843-572-1528
Practice Address - Street 1:7801 RIVERS AVE
Practice Address - Street 2:SEARS BUILDING
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4015
Practice Address - Country:US
Practice Address - Phone:843-572-6622
Practice Address - Fax:843-572-1528
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD10815Medicaid
SCD10815Medicaid
SCU68950Medicare UPIN