Provider Demographics
NPI:1134282437
Name:HODSON, PAUL M III
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:HODSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1205
Mailing Address - Country:US
Mailing Address - Phone:716-875-4507
Mailing Address - Fax:716-874-0332
Practice Address - Street 1:1567 MILITARY RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1205
Practice Address - Country:US
Practice Address - Phone:716-875-4507
Practice Address - Fax:716-874-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY004926-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1315350001Medicare ID - Type Unspecified