Provider Demographics
NPI:1346422417
Name:HOFFMAN, ALBERT JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JOSEPH
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-0117
Mailing Address - Country:US
Mailing Address - Phone:440-593-4005
Mailing Address - Fax:440-593-5706
Practice Address - Street 1:237 SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2525
Practice Address - Country:US
Practice Address - Phone:440-593-4005
Practice Address - Fax:440-593-5706
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3540 T235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0545048Medicaid
OH0545048Medicaid
OH0535221Medicare PIN