=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790809648
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN HENRY HOELSCHER O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3301 N PONTIAC TRL
-----------------------------------------------------
City | COMMERCE TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48390-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-668-0287
-----------------------------------------------------
Fax | 248-668-0290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37157 FOX CHASE
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48331-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-421-7597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901003614
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------