Provider Demographics
NPI:1932280054
Name:VAN HOOSE, MARC CAMERON (OD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:CAMERON
Last Name:VAN HOOSE
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 1:7246 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1007
Mailing Address - Country:US
Mailing Address - Phone:760-560-7501
Mailing Address - Fax:
Practice Address - Street 1:7246 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1007
Practice Address - Country:US
Practice Address - Phone:760-560-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0126670Medicaid
CASD0126670Medicaid
CABZ101AMedicare PIN