Individual
JACK L HOSTETLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2680 S VAL VISTA DR, #111, GILBERT, AZ 85295-2152
(480) 807-0288
(480) 299-7199
Mailing address
2680 S VAL VISTA DR, #111, GILBERT, AZ 85295-2152
(480) 807-0288
(480) 299-7199
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
349
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
860439395
—
AZ
Enumeration date
06/09/2005
Last updated
06/25/2008
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