Provider Demographics
NPI:1407283955
Name:HOSEK, DORI K (BCO, BADO)
Entity Type:Individual
Prefix:MS
First Name:DORI
Middle Name:K
Last Name:HOSEK
Suffix:
Gender:F
Credentials:BCO, BADO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 MARSHALL CT.
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2288
Mailing Address - Country:US
Mailing Address - Phone:608-661-9030
Mailing Address - Fax:608-231-2949
Practice Address - Street 1:2725 MARSHALL CT.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2288
Practice Address - Country:US
Practice Address - Phone:608-661-9030
Practice Address - Fax:608-231-2949
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41744100Medicaid