=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760704555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOHENBARY EYE CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2010
-----------------------------------------------------
Last Update Date | 10/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1204 AVENUE OF MID AMERICA
-----------------------------------------------------
City | EFFINGHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62401-4715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-342-2547
-----------------------------------------------------
Fax | 217-342-6294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15022 N HAARMANN AVE
-----------------------------------------------------
City | EFFINGHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62401-4484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-881-0122
-----------------------------------------------------
Fax | 217-881-0122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. G. JOSHUA T. HOHENBARY
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 217-881-0122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 060008636
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------