Provider Demographics
NPI:1447240205
Name:HYRE, EDWARD CLIFTON (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CLIFTON
Last Name:HYRE
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 1:115 WILTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3260
Mailing Address - Country:US
Mailing Address - Phone:304-636-5175
Mailing Address - Fax:304-636-5175
Practice Address - Street 1:1500 HARRISON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3327
Practice Address - Country:US
Practice Address - Phone:304-636-9111
Practice Address - Fax:614-923-9575
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV565OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150280000Medicaid
WV9006601Medicare PIN
WVT32458Medicare UPIN