Healthcare Provider Details

I. General information

NPI: 1093358459
Provider Name (Legal Business Name): DR. JOHN A HOGG, OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E CARMEL DR
MERIDIAN ID
83646-3301
US

IV. Provider business mailing address

9012 132ND PL SE
NEWCASTLE WA
98059-3333
US

V. Phone/Fax

Practice location:
  • Phone: 260-414-5599
  • Fax:
Mailing address:
  • Phone: 260-414-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN A HOGG
Title or Position: PRESIDENT
Credential: OD
Phone: 260-414-5599