Provider Demographics
NPI:1184696346
Name:HYATT, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:HYATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1624
Mailing Address - Country:US
Mailing Address - Phone:541-488-3192
Mailing Address - Fax:541-488-0646
Practice Address - Street 1:246 CATALINA DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1624
Practice Address - Country:US
Practice Address - Phone:541-488-3192
Practice Address - Fax:541-488-0646
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45882207W00000X
SC34419207W00000X
ORMD176865207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01236562OtherRAILROAD MEDICARE
OR500707611Medicaid
SC344194Medicaid
SC344194Medicaid
SC5912Medicare PIN
OR500707611Medicaid
SC5909Medicare PIN
SCP01236562OtherRAILROAD MEDICARE