Healthcare Provider Details

I. General information

NPI: 1639211402
Provider Name (Legal Business Name): HOGAN EYE ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LOUDON RD SUITE 5
CONCORD NH
03301-5611
US

IV. Provider business mailing address

133 LOUDON RD SUITE 5
CONCORD NH
03301-5611
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3351
  • Fax: 603-224-7575
Mailing address:
  • Phone: 603-224-3351
  • Fax: 603-224-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0540
License Number StateNH

VIII. Authorized Official

Name: MR. TIMOTHY J HOGAN
Title or Position: OPTOMETRY
Credential: OD
Phone: 603-224-3351