Provider Demographics
NPI:1770514853
Name:HOSKINS, TAMMY GWYN (OD)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:GWYN
Last Name:HOSKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1634
Mailing Address - Country:US
Mailing Address - Phone:859-734-3155
Mailing Address - Fax:859-734-3159
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1634
Practice Address - Country:US
Practice Address - Phone:859-734-3155
Practice Address - Fax:859-734-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1205DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY203382931OtherFEDERAL TAX I.D. NUMBER
KY1205DTOtherSTATE LICENSE NUMBER
KY77012052Medicaid
KY77012052Medicaid
KYU12300Medicare UPIN