Provider Demographics
NPI:1164762423
Name:EMILY HOSACK, LLC
Entity Type:Organization
Organization Name:EMILY HOSACK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOSACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-774-2017
Mailing Address - Street 1:229 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-1615
Mailing Address - Country:US
Mailing Address - Phone:814-774-2017
Mailing Address - Fax:
Practice Address - Street 1:229 MAIN ST W
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-1615
Practice Address - Country:US
Practice Address - Phone:814-774-2017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102617639Medicaid
PA102617639Medicaid