Healthcare Provider Details

I. General information

NPI: 1760704555
Provider Name (Legal Business Name): HOHENBARY EYE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
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 Number060008636
License Number StateIL

VIII. Authorized Official

Name: DR. G. JOSHUA T. HOHENBARY
Title or Position: PRESIDENT
Credential: O.D.
Phone: 217-881-0122