Healthcare Provider Details

I. General information

NPI: 1487621678
Provider Name (Legal Business Name): MARY C. HOHENBERGER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 N HIGHWAY 67
FLORISSANT MO
63031-2917
US

IV. Provider business mailing address

211 E BROADWAY
ALTON IL
62002-6220
US

V. Phone/Fax

Practice location:
  • Phone: 314-838-7644
  • Fax: 800-432-6004
Mailing address:
  • Phone: 618-462-9818
  • Fax: 800-432-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO2898
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008348
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: