Provider Demographics
NPI:1831243534
Name:DAN R. HOST, O.D., P.C.
Entity type:Organization
Organization Name:DAN R. HOST, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-356-4322
Mailing Address - Street 1:518 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-2747
Mailing Address - Country:US
Mailing Address - Phone:260-356-4322
Mailing Address - Fax:260-356-4326
Practice Address - Street 1:518 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-2747
Practice Address - Country:US
Practice Address - Phone:260-356-4322
Practice Address - Fax:260-356-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200504770AMedicaid
IN220110Medicare PIN
5609390001Medicare NSC
410047475Medicare PIN
IN200504770AMedicaid