Healthcare Provider Details

I. General information

NPI: 1952580946
Provider Name (Legal Business Name): TIMOTHY J HOGAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
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: 603-225-7575
Mailing address:
  • Phone: 603-224-3351
  • Fax: 603-225-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: