Provider Demographics
NPI:1578523304
Name:HOOVER, NATHAN T (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:T
Last Name:HOOVER
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 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-569-9550
Mailing Address - Fax:260-569-0760
Practice Address - Street 1:374 INDIAN BOUNDARY RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:219-395-1575
Practice Address - Fax:219-395-1676
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003116A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200336940Medicaid
IN160450005Medicare PIN
IN452570012Medicare PIN
INP00381747Medicare PIN
IN237280BMedicare PIN
IN669220009Medicare PIN
IN236930BMedicare PIN
IN262620BMedicare PIN
U86706Medicare UPIN
IN200336940Medicaid