Provider Demographics
NPI:1336131630
Name:HOCKEMEYER, TROY S (OD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:S
Last Name:HOCKEMEYER
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 1:1010 BOULDER RIDGE TRAIL
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-9577
Mailing Address - Country:US
Mailing Address - Phone:260-493-1505
Mailing Address - Fax:260-493-2651
Practice Address - Street 1:1010 BOULDER RIDGE TRL
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-0010
Practice Address - Country:US
Practice Address - Phone:260-493-1505
Practice Address - Fax:260-493-2651
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-03-11
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IN18002750B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300087496Medicaid
IN410029181OtherRR MEDICARE
IN200055250Medicaid
IN084430Medicare ID - Type Unspecified
IN1047220002Medicare NSC