Provider Demographics
NPI:1851574107
Name:HOGAN, WILLIAM (LDO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HOGAN
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 NW 11TH PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4254
Mailing Address - Country:US
Mailing Address - Phone:352-331-1933
Mailing Address - Fax:
Practice Address - Street 1:6830 NW 11TH PL
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4254
Practice Address - Country:US
Practice Address - Phone:352-331-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 431156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0920240001Medicare PIN