Provider Demographics
NPI:1346233889
Name:HOGAN, CASEY L (OD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:L
Last Name:HOGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4718
Mailing Address - Country:US
Mailing Address - Phone:708-229-2200
Mailing Address - Fax:708-229-2233
Practice Address - Street 1:4619 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4718
Practice Address - Country:US
Practice Address - Phone:708-229-2200
Practice Address - Fax:708-229-2233
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009033Medicaid
ILU68860Medicare PIN
IL046009033Medicaid
ILL40302Medicare PIN