Provider Demographics
NPI:1982082731
Name:HOCHSTETLER, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HOCHSTETLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8809 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-7064
Mailing Address - Country:US
Mailing Address - Phone:616-648-5141
Mailing Address - Fax:
Practice Address - Street 1:8809 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-7064
Practice Address - Country:US
Practice Address - Phone:616-648-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010907152W00000X
MI4901004954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400226865Medicare PIN