Basic Information
| Provider Information | |||||||||
| NPI: | 1790997419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOCHREITER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6195 SOUTHBROOK DR | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145199211 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 603 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145802316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856713300 | ||||||||
| FaxNumber: | 5856712540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 210 | AK | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 007485 | NY | Y | Eye and Vision Services Providers | Optometrist | 152WP0200X | 007485 | NY | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152WC0802X | 007485 | NY | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
ID Information
| ID | Type | State | Issuer | Description | OD86651 | 05 | AK | MEDICAID |