Provider Demographics
NPI:1386672160
Name:HYNDMAN, DAVID G (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:HYNDMAN
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:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-0248
Mailing Address - Country:US
Mailing Address - Phone:812-897-5000
Mailing Address - Fax:812-897-5000
Practice Address - Street 1:1001 MILLIS AVE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2239
Practice Address - Country:US
Practice Address - Phone:812-897-5000
Practice Address - Fax:812-897-4539
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002821B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200120910Medicaid
IN1194200001Medicare NSC
INU63006Medicare UPIN
IN166530Medicare ID - Type Unspecified