Healthcare Provider Details

I. General information

NPI: 1831269430
Provider Name (Legal Business Name): MATTHEW HOCHWALT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 MADISON RD
CINCINNATI OH
45209-1709
US

IV. Provider business mailing address

3039 MADISON RD
CINCINNATI OH
45209-1709
US

V. Phone/Fax

Practice location:
  • Phone: 513-651-4005
  • Fax: 513-651-4006
Mailing address:
  • Phone: 513-651-4005
  • Fax: 513-651-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5394T2305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: