MEDICARE: DR. HANNAH DEGROOT KOCH OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18004556A	IN

General Provider Information

NPI Number	:	1073318424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANNAH DEGROOT KOCH OD

Provider Business Mailing Address
First Line	:	2835 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-2147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 17TH ST
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-1901
Country	:	US
Telephone Number	:	765-457-5384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	05/08/2026

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