Provider Demographics
NPI:1992815344
Name:HYATT, LINDA JEAN
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:HYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JEAN
Other - Last Name:HARGREAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16936 SE POWELL BLVD
Mailing Address - Street 2:APT 68
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-8714
Mailing Address - Country:US
Mailing Address - Phone:503-491-1130
Mailing Address - Fax:
Practice Address - Street 1:16936 SE POWELL BLVD
Practice Address - Street 2:APT 68
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-8714
Practice Address - Country:US
Practice Address - Phone:503-491-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00001926156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician