Provider Demographics
NPI:1487681292
Name:HATCH, DARREN (OD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:
Last Name:HATCH
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 1:49 E 1ST S
Mailing Address - Street 2:POBOX 577
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1966
Mailing Address - Country:US
Mailing Address - Phone:208-356-4444
Mailing Address - Fax:208-356-4445
Practice Address - Street 1:49 E 1ST S
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1966
Practice Address - Country:US
Practice Address - Phone:208-356-4444
Practice Address - Fax:208-356-4445
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804086300Medicaid
ID0645750001Medicare NSC
ID1593373Medicare PIN
ID804086300Medicaid