Provider Demographics
NPI:1477746295
Name:HOGG, JOHN A (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:HOGG
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 1:50 E CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3301
Mailing Address - Country:US
Mailing Address - Phone:208-888-5252
Mailing Address - Fax:
Practice Address - Street 1:50 E CARMEL DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3301
Practice Address - Country:US
Practice Address - Phone:208-888-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004098152W00000X
IDODP-100493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist