Provider Demographics
NPI:1467546747
Name:HOHENBARY, GEORGE JOSHUA TODD (OD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE JOSHUA
Middle Name:TODD
Last Name:HOHENBARY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15022 N HAARMANN AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4484
Mailing Address - Country:US
Mailing Address - Phone:217-881-0122
Mailing Address - Fax:217-881-0122
Practice Address - Street 1:1204 AVENUE OF MID AMERICA
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4715
Practice Address - Country:US
Practice Address - Phone:217-342-2547
Practice Address - Fax:217-342-6294
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV02088Medicare UPIN
IL210238Medicare ID - Type UnspecifiedPROVIDER NUMBER