Frederick Mathew Hornack Jr., OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

NC 1119 Issued in NC

Practice address

204 South Main Street
Stanley, NC 28164

Phone

(704) 263-2020

Fax

(704) 263-2011

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154482230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 WILLOW ST",
            "city": "STANLEY",
            "state": "NC",
            "postal_code": "281641657",
            "telephone_number": "704-263-5942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SOUTH MAIN STREET",
            "city": "STANLEY",
            "state": "NC",
            "postal_code": "28164",
            "telephone_number": "704-263-2020",
            "fax_number": "704-263-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORNACK",
        "first_name": "FREDERICK",
        "middle_name": "MATHEW",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "NC 1119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909421",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Stanley, NC
• Providers in Stanley, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.