Provider Demographics
NPI:1710013222
Name:HOOVER, HAROLD JEFFERY (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:JEFFERY
Last Name:HOOVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4091 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-4021
Mailing Address - Country:US
Mailing Address - Phone:706-284-8724
Mailing Address - Fax:706-863-1800
Practice Address - Street 1:3450 WRIGHTSBORO RD
Practice Address - Street 2:JC PENNY OPTICAL
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2516
Practice Address - Country:US
Practice Address - Phone:706-667-8336
Practice Address - Fax:706-863-1800
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1138OtherGA LIC.
SC846OtherSC LIC.
AL632OtherAL LIC.
AL632OtherAL LIC.
SC846OtherSC LIC.