Provider Demographics
NPI: | 1457445991 |
---|---|
Name: | HOOK, TODD WALTON (OD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | TODD |
Middle Name: | WALTON |
Last Name: | HOOK |
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: | 2701 SE G ST STE 1 |
Mailing Address - Street 2: | |
Mailing Address - City: | BENTONVILLE |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72712-3783 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 479-254-3937 |
Mailing Address - Fax: | 479-254-3938 |
Practice Address - Street 1: | 2701 SE G ST |
Practice Address - Street 2: | STE 1 |
Practice Address - City: | BENTONVILLE |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72712 |
Practice Address - Country: | US |
Practice Address - Phone: | 479-254-3937 |
Practice Address - Fax: | 479-254-3938 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-10-02 |
Last Update Date: | 2023-01-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AR | 2451 | 152W00000X |
MO | T03312 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 318563301 | Medicaid | |
AR | U62157 | Medicare UPIN | |
AR | 49101 | Medicare ID - Type Unspecified | |
1265730001 | Medicare NSC | ||
MO | 318563301 | Medicaid | |
MO | 000091017 | Medicare ID - Type Unspecified |