Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1568DT | KY |
NPI | 1356343990 |
---|---|
Provider Name | Dr. Julie Hogan |
First Address | Louisville, KY 40217-1417 |
Second Address | Louisville, KY 40217-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000319123 | ANTHEM (01) | KY |
77001139 | (05) | KY |
921353 | BLOCK VISION (01) | |
U96550 | (02) |