Provider Demographics
NPI:1962570663
Name:HOYT, MICHAEL G (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HOYT
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 1:215 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2043
Mailing Address - Country:US
Mailing Address - Phone:541-708-5350
Mailing Address - Fax:
Practice Address - Street 1:215 FOURTH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2043
Practice Address - Country:US
Practice Address - Phone:541-708-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3011T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001191001OtherBLUE CROSS BLUE SHIELD
OR119789Medicaid
410022268OtherRAILROAD MEDICARE
041WCGJJBMedicare ID - Type Unspecified
OR119789Medicaid