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General NPI Number Information
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NPI Number | 1922019587
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Entity Type | Organization
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Legal Business Name | JUSTIN W HOGLE OD PLLC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 2500 CHANDLER RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-5003
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Country | US
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Telephone | 918-683-3937
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Fax | 918-683-3945
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Provider Business Mailing Address
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Address Line | 2500 CHANDLER RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-5003
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Country | US
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Telephone | 918-683-3937
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Fax | 918-683-3945
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Authorized Official
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Title or Position | OWNER OD
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Name | MR. JUSTIN WARREN HOGLE
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Credential | OD
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Telephone | 918-683-3937
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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 | 2453
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License Number State | OK
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