Provider Demographics
NPI:1114069390
Name:BURBANK FAMILY OPTOMETRY INC
Entity Type:Organization
Organization Name:BURBANK FAMILY OPTOMETRY INC
Other - Org Name:WAYNE HOEFT & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOEFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-846-9075
Mailing Address - Street 1:907 N SAN FERNANDO BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4326
Mailing Address - Country:US
Mailing Address - Phone:818-846-9075
Mailing Address - Fax:818-846-9010
Practice Address - Street 1:907 N SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4326
Practice Address - Country:US
Practice Address - Phone:818-846-9075
Practice Address - Fax:818-846-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8494T152WC0802X
CAOPT 4256 TPA152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114069390Medicaid
CA1801851571OtherPROVIDER NPI
CADE850AOtherMEDICARE PTAN (GROUP)
CADF035ZOtherMEDICARE PTAN (INDIVIDUAL)
CA1114069390Medicaid
CADF035ZOtherMEDICARE PTAN (INDIVIDUAL)
CA1801851571OtherPROVIDER NPI
CAWOP4256BMedicare PIN