Provider Demographics
NPI:1922019587
Name:JUSTIN W HOGLE OD PLLC
Entity Type:Organization
Organization Name:JUSTIN W HOGLE OD PLLC
Other - Org Name:HOGLE EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OD
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:HOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-683-3937
Mailing Address - Street 1:2500 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5003
Mailing Address - Country:US
Mailing Address - Phone:918-683-3937
Mailing Address - Fax:918-683-3945
Practice Address - Street 1:2500 CHANDLER RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5003
Practice Address - Country:US
Practice Address - Phone:918-683-3937
Practice Address - Fax:918-683-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20079150AMedicaid
OK5768860001Medicare NSC
V07545Medicare UPIN
OK20079150AMedicaid