MEDICARE: DR. JULIE HOGAN 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	152WC0802X	Corneal and Contact Management Optometrist	1568DT	KY
2	152W00000X	Optometrist	1568DT	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000319123	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	921353	OTHER		BLOCK VISION

General Provider Information

NPI Number	:	1356343990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE HOGAN OD

Provider Business Mailing Address
First Line	:	6400 DUTCHMANS PKWY STE 125
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3342
Country	:	US
Telephone Number	:	502-896-8700
Fax Number	:	502-896-0813

Provider Business Practice Location Address
First Line	:	1169 EASTERN PKWY
Second Line	:	STE 3334
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1417
Country	:	US
Telephone Number	:	502-458-9004
Fax Number	:	502-458-9842

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/10/2023

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Directions to “ DR. JULIE HOGAN OD” Practice Location

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