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General NPI Number Information
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NPI Number | 1316018492
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Entity Type | Individual
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Provider Name | DOUGLAS JOHN HODGSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 2552 E 3RD ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7882
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Country | US
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Telephone | 812-332-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 E 2ND ST # 96438
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City | CASPER
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State | WY
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Zip | 82609-4308
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Country | US
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Telephone | 307-277-5282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 268T
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003064A
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License Number State | IN
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