Provider Demographics
NPI:1720245863
Name:MICHAEL HODOVANIC OD
Entity Type:Organization
Organization Name:MICHAEL HODOVANIC OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HODOVANIC
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:513-821-5710
Mailing Address - Street 1:24 COMPTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-1000
Mailing Address - Country:US
Mailing Address - Phone:513-821-5710
Mailing Address - Fax:513-821-5711
Practice Address - Street 1:24 COMPTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1000
Practice Address - Country:US
Practice Address - Phone:513-821-5710
Practice Address - Fax:513-821-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0189860001Medicare NSC