Provider Demographics
NPI:1134325574
Name:ROBERT L HOFFMAN OD PC
Entity Type:Organization
Organization Name:ROBERT L HOFFMAN OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:219-659-1105
Mailing Address - Street 1:1703 CALUMET AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1414
Mailing Address - Country:US
Mailing Address - Phone:219-659-1105
Mailing Address - Fax:
Practice Address - Street 1:1703 CALUMET AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1414
Practice Address - Country:US
Practice Address - Phone:219-659-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001590A&B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU22738Medicare UPIN
IN150450Medicare PIN
IN0208960001Medicare NSC
INDG3727Medicare PIN