Provider Demographics
NPI:1548486863
Name:HOGLAN, LEE NICKLIN (OD,)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:NICKLIN
Last Name:HOGLAN
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 1:18568 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3646
Mailing Address - Country:US
Mailing Address - Phone:408-253-1990
Mailing Address - Fax:
Practice Address - Street 1:18568 PROSPECT RD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-3646
Practice Address - Country:US
Practice Address - Phone:408-253-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6249T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist