Provider Demographics
NPI:1194923276
Name:HYDE PARK OPTOMETRISTS, INC.
Entity type:Organization
Organization Name:HYDE PARK OPTOMETRISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-871-5200
Mailing Address - Street 1:2731 OBSERVATORY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2107
Mailing Address - Country:US
Mailing Address - Phone:513-871-5200
Mailing Address - Fax:513-871-5446
Practice Address - Street 1:2731 OBSERVATORY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2107
Practice Address - Country:US
Practice Address - Phone:513-871-5200
Practice Address - Fax:513-871-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3607 T923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1105380001Medicare NSC
T47833Medicare UPIN
OH0530752Medicare PIN