Provider Demographics
NPI:1932297116
Name:HYDE, IVAN D (OD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:D
Last Name:HYDE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:18631 ALDERWOOD MALL PKWY
Mailing Address - Street 2:#105
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-8014
Mailing Address - Country:US
Mailing Address - Phone:425-771-2662
Mailing Address - Fax:425-670-2333
Practice Address - Street 1:18631 ALDERWOOD MALL PKWY
Practice Address - Street 2:#105
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8014
Practice Address - Country:US
Practice Address - Phone:425-771-2662
Practice Address - Fax:425-670-2333
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOD00001345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU26743Medicare UPIN