Healthcare Provider Details

I. General information

NPI: 1881759744
Provider Name (Legal Business Name): CHRISTOPHER HOGAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5023 MUD LN 110
LOUISVILLE KY
40229-2800
US

IV. Provider business mailing address

4000 POPLAR LEVEL RD
LOUISVILLE KY
40213-1524
US

V. Phone/Fax

Practice location:
  • Phone: 502-968-2015
  • Fax: 502-964-1915
Mailing address:
  • Phone: 502-459-2020
  • Fax: 502-456-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1567DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: