Provider Demographics
NPI:1841280807
Name:HYDE, MICHAEL G (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:HYDE
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 1:122 PARK HILLS PLZ
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2812
Mailing Address - Country:US
Mailing Address - Phone:814-946-0330
Mailing Address - Fax:
Practice Address - Street 1:122 PARK HILLS PLZ
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2812
Practice Address - Country:US
Practice Address - Phone:814-946-0330
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007177T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist