Provider Demographics
NPI:1659363406
Name:HOCKING, DOUGLAS D (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:HOCKING
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 1:107 PLAZA DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8735
Mailing Address - Country:US
Mailing Address - Phone:740-695-0444
Mailing Address - Fax:740-695-0444
Practice Address - Street 1:107 PLAZA DR
Practice Address - Street 2:SUITE L
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8786
Practice Address - Country:US
Practice Address - Phone:740-695-0444
Practice Address - Fax:740-695-0444
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2008-09-09
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
OH3416/T746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0494891Medicare PIN
OHT47282Medicare UPIN
OH0531120001Medicare NSC