Healthcare Provider Details

I. General information

NPI: 1467546747
Provider Name (Legal Business Name): GEORGE JOSHUA TODD HOHENBARY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 AVENUE OF MID AMERICA
EFFINGHAM IL
62401-4715
US

IV. Provider business mailing address

15022 N HAARMANN AVE
EFFINGHAM IL
62401-4484
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-2547
  • Fax: 217-342-6294
Mailing address:
  • Phone: 217-881-0122
  • Fax: 217-881-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.009657
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: