Provider Demographics
NPI:1295882033
Name:HOOTON, JEFFREY MARK (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:HOOTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2732 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5412
Mailing Address - Country:US
Mailing Address - Phone:903-597-9020
Mailing Address - Fax:903-597-4049
Practice Address - Street 1:2732 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5412
Practice Address - Country:US
Practice Address - Phone:903-597-9020
Practice Address - Fax:903-597-4049
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6744TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist