Provider Demographics
NPI:1497871362
Name:HOOKWAY EYE CARE INC
Entity Type:Organization
Organization Name:HOOKWAY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOOKWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-933-2741
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-0270
Mailing Address - Country:US
Mailing Address - Phone:419-933-2741
Mailing Address - Fax:419-933-7281
Practice Address - Street 1:320 W WALTON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9133
Practice Address - Country:US
Practice Address - Phone:419-933-2741
Practice Address - Fax:419-933-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3612152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0506714Medicaid
OH0530732Medicare PIN
OHT47831Medicare UPIN
OH0506714Medicaid