Provider Demographics
NPI:1497739106
Name:HIDER, STEVEN SAGE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SAGE
Last Name:HIDER
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 1:7605 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4433
Mailing Address - Country:US
Mailing Address - Phone:805-466-3777
Mailing Address - Fax:805-466-3700
Practice Address - Street 1:7605 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4433
Practice Address - Country:US
Practice Address - Phone:805-466-3777
Practice Address - Fax:805-466-3700
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10330OtherSTATE OPTOMETRIC LICENSE
CACD1699OtherMEDICARE RAILROAD
CASD0103300Medicaid
CASD0103300Medicaid
CA10330OtherSTATE OPTOMETRIC LICENSE
CAWOP10330AMedicare PIN
CAWOP10330BMedicare PIN