Provider Demographics
NPI:1003159542
Name:HOEKSTRA OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:HOEKSTRA OPTOMETRIC CORPORATION
Other - Org Name:UNION VISION SERVICES OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-782-8080
Mailing Address - Street 1:2200 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7763
Mailing Address - Country:US
Mailing Address - Phone:916-782-8080
Mailing Address - Fax:916-772-2329
Practice Address - Street 1:2200 PROFESSIONAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7763
Practice Address - Country:US
Practice Address - Phone:916-782-8080
Practice Address - Fax:916-772-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12419T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHD156AMedicare PIN