Provider Demographics
NPI:1851417695
Name:HOGUE, ANDREW B (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:HOGUE
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 1:10529 HOSLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9736
Mailing Address - Country:US
Mailing Address - Phone:260-627-2669
Mailing Address - Fax:260-627-2011
Practice Address - Street 1:10529 HOSLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:LEO
Practice Address - State:IN
Practice Address - Zip Code:46765-9736
Practice Address - Country:US
Practice Address - Phone:260-627-2669
Practice Address - Fax:260-627-2011
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002634A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200301060Medicaid
IN200301060Medicaid
INM400014908Medicare PIN