Provider Demographics
NPI:1669467452
Name:HYATT III, C WADE
Entity Type:Individual
Prefix:
First Name:C WADE
Middle Name:
Last Name:HYATT III
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 EDMONDSON PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5872
Mailing Address - Country:US
Mailing Address - Phone:615-331-8688
Mailing Address - Fax:
Practice Address - Street 1:5505 EDMONDSON PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5869
Practice Address - Country:US
Practice Address - Phone:615-331-8688
Practice Address - Fax:615-331-2273
Is Sole Proprietor?:No
Enumeration Date:2005-09-17
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1474T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN41004420OtherRAILROAD MEDICARE/CHEATHAM CO EYECARE
TN410047740OtherRAILROAD MEDICARE/NASHVILLE EYE GRP
TN410047740OtherRAILROAD MEDICARE/NASHVILLE EYE GRP
TNU46376Medicare UPIN
TN3599056Medicare PIN