Healthcare Provider Details

I. General information

NPI: 1649440116
Provider Name (Legal Business Name): HOSKO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LEGACY PLZ W
LA PORTE IN
46350-5298
US

IV. Provider business mailing address

106 LEGACY PLAZA WEST
LAPORTE IN
46350
US

V. Phone/Fax

Practice location:
  • Phone: 219-362-2685
  • Fax: 219-362-5587
Mailing address:
  • Phone: 219-362-2685
  • Fax: 219-362-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002697
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number18002697
License Number StateIN

VIII. Authorized Official

Name: DR. KYLE HOSKINS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 574-276-0226