Provider Demographics
NPI:1194947895
Name:HOCHSTATTER, JEANETTE RAE (OD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:RAE
Last Name:HOCHSTATTER
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 1:635 GLASGOW CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-2908
Mailing Address - Country:US
Mailing Address - Phone:925-362-8176
Mailing Address - Fax:
Practice Address - Street 1:5442 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3800
Practice Address - Country:US
Practice Address - Phone:925-672-4100
Practice Address - Fax:925-672-4195
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8740 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS335AMedicare PIN