Provider Demographics
NPI:1750485017
Name:DAVID J HEDGES MD PC
Entity Type:Organization
Organization Name:DAVID J HEDGES MD PC
Other - Org Name:EYE SURGERY ASSOCIATES OF SWVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-552-4573
Mailing Address - Street 1:110 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-552-4573
Mailing Address - Fax:540-552-4612
Practice Address - Street 1:110 PROFESSIONAL PARK DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060
Practice Address - Country:US
Practice Address - Phone:540-552-4573
Practice Address - Fax:540-552-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032459207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6357849Medicaid
B05125Medicare UPIN
VA6357849Medicaid