Provider Demographics
NPI:1477525780
Name:HOGAN, WILLARD JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:JOSEPH
Last Name:HOGAN
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:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-1233
Mailing Address - Country:US
Mailing Address - Phone:866-894-5888
Mailing Address - Fax:866-894-5888
Practice Address - Street 1:12020 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1655
Practice Address - Country:US
Practice Address - Phone:509-444-0004
Practice Address - Fax:866-894-5888
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8908268OtherMEDICARE PTAN
WAG8908268OtherMEDICARE PTAN