Provider Demographics
NPI:1952580946
Name:HOGAN, TIMOTHY J (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:HOGAN
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 1:133 LOUDON RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5611
Mailing Address - Country:US
Mailing Address - Phone:603-224-3351
Mailing Address - Fax:603-225-7575
Practice Address - Street 1:133 LOUDON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5611
Practice Address - Country:US
Practice Address - Phone:603-224-3351
Practice Address - Fax:603-225-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE0623Medicare UPIN