Provider Demographics
NPI:1376032326
Name:FRECHETTE, HAYDEN M (OD)
Entity Type:Individual
Prefix:DR
First Name:HAYDEN
Middle Name:M
Last Name:FRECHETTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 EUCLID AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3700
Mailing Address - Country:US
Mailing Address - Phone:276-466-4227
Mailing Address - Fax:276-466-3937
Practice Address - Street 1:1701 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3700
Practice Address - Country:US
Practice Address - Phone:276-466-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
390200000X
VA0618002654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9203771Medicaid