Provider Demographics
NPI:1073540035
Name:HOELTING, CARL R (OD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:HOELTING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-938-2650
Practice Address - Street 1:7342 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3108
Practice Address - Country:US
Practice Address - Phone:314-645-1575
Practice Address - Fax:314-645-8001
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO314693904Medicaid
MOMA5227050Medicare UPIN
MO314693904Medicaid
MOT42593Medicare UPIN