Provider Demographics
NPI:1083777809
Name:HOSFORD, MICHAEL K (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:HOSFORD
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 1:3099 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-1667
Mailing Address - Country:US
Mailing Address - Phone:616-285-7718
Mailing Address - Fax:616-949-5616
Practice Address - Street 1:3099 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1667
Practice Address - Country:US
Practice Address - Phone:616-285-7718
Practice Address - Fax:616-949-5616
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist