Provider Demographics
NPI:1376815258
Name:HYDER INC
Entity Type:Organization
Organization Name:HYDER INC
Other - Org Name:EYE TRENDS CLEARLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-488-0066
Mailing Address - Street 1:515 BAY AREA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2663
Mailing Address - Country:US
Mailing Address - Phone:281-488-0066
Mailing Address - Fax:281-488-0601
Practice Address - Street 1:515 BAY AREA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2663
Practice Address - Country:US
Practice Address - Phone:281-488-0066
Practice Address - Fax:281-488-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3183T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3183TOtherTEXAS OPTOMETRY LICENSE