Provider Demographics
NPI:1871580548
Name:HEDRICK, DENNIS WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WAYNE
Last Name:HEDRICK
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 1:806 GREENBRIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1527
Mailing Address - Country:US
Mailing Address - Phone:304-342-5900
Mailing Address - Fax:304-342-6257
Practice Address - Street 1:806 GREENBRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1527
Practice Address - Country:US
Practice Address - Phone:304-342-5900
Practice Address - Fax:304-342-6257
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV870-OD152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149490000Medicaid
WVMHO286369OtherDEA NUMBER
WVHE0681395Medicare ID - Type Unspecified
WV0149490000Medicaid