Provider Demographics
NPI:1235103227
Name:HOCK, DANIEL R (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:HOCK
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 1:30960 STAGECOACH BLVD
Mailing Address - Street 2:STE W-200
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7902
Mailing Address - Country:US
Mailing Address - Phone:303-674-4143
Mailing Address - Fax:303-670-4081
Practice Address - Street 1:30960 STAGECOACH BLVD
Practice Address - Street 2:STE W-200
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7902
Practice Address - Country:US
Practice Address - Phone:303-674-4143
Practice Address - Fax:303-670-4081
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCD1013Medicare PIN
COU58623Medicare UPIN