Provider Demographics
NPI:1386657179
Name:HOGAN, LINDA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LEE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:LEE
Other - Last Name:KEARNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1508 WILLOWBROOK MALL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-890-0861
Mailing Address - Fax:973-890-0956
Practice Address - Street 1:1508 WILLOWBROOK MALL
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-890-0861
Practice Address - Fax:973-890-0956
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00593200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042943Medicaid
NJ084115CQTMedicare PIN