Provider Demographics
NPI:1649373689
Name:HOSTER, KIRK F (OD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:F
Last Name:HOSTER
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 1845
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-1845
Mailing Address - Country:US
Mailing Address - Phone:405-275-2020
Mailing Address - Fax:405-275-4129
Practice Address - Street 1:2109 N KICKAPOO AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2732
Practice Address - Country:US
Practice Address - Phone:405-275-2020
Practice Address - Fax:405-275-4129
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK150885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764300AMedicaid
OK731350800OtherEIN
0577720001Medicare NSC
OK100764300AMedicaid