Provider Demographics
NPI:1003192162
Name:BLAKE J. HOFFMAN, OD, PA
Entity Type:Organization
Organization Name:BLAKE J. HOFFMAN, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-527-2965
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-0130
Mailing Address - Country:US
Mailing Address - Phone:785-527-2965
Mailing Address - Fax:785-527-2709
Practice Address - Street 1:2204 M ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2244
Practice Address - Country:US
Practice Address - Phone:785-527-2965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty