Provider Demographics
NPI:1710988076
Name:HOOKWAY, LARRY A (OD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:HOOKWAY
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 207170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7156
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:1725 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2705
Practice Address - Country:US
Practice Address - Phone:614-861-7771
Practice Address - Fax:614-861-8774
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0506714Medicaid
OH0506714Medicaid
OH0530731Medicare PIN
OH0686220001Medicare NSC