Provider Demographics
NPI:1326037557
Name:HODOVANIC, MICHAEL JOSEPH III (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HODOVANIC
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:24 COMPTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-1000
Mailing Address - Country:US
Mailing Address - Phone:513-821-5710
Mailing Address - Fax:513-821-5711
Practice Address - Street 1:24 COMPTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1000
Practice Address - Country:US
Practice Address - Phone:513-821-5710
Practice Address - Fax:513-821-5711
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48065Medicare UPIN
OHHO0551221Medicare ID - Type Unspecified