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General NPI Number Information
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NPI Number | 1003159542
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Entity Type | Organization
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Legal Business Name | HOEKSTRA OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 2200 PROFESSIONAL DR SUITE 250
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City | ROSEVILLE
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State | CA
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Zip | 95661-7763
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Country | US
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Telephone | 916-782-8080
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Fax | 916-772-2329
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Provider Business Mailing Address
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Address Line | 2200 PROFESSIONAL DR SUITE 250
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City | ROSEVILLE
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State | CA
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Zip | 95661-7763
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Country | US
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Telephone | 916-782-8080
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Fax | 916-772-2329
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Authorized Official
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Title or Position | PRESIDENT
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Name | COREY HOEKSTRA
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Credential | O.D.
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Telephone | 916-782-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12419T
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License Number State | CA
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