Provider Demographics
NPI:1427191881
Name:HOFMANN, ALYCE ANASTASIA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALYCE
Middle Name:ANASTASIA
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 REENA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-3145
Mailing Address - Country:US
Mailing Address - Phone:920-563-8468
Mailing Address - Fax:
Practice Address - Street 1:740 REENA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-3145
Practice Address - Country:US
Practice Address - Phone:920-563-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009524152W00000X
WI3138-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP01734884OtherRAILROAD MEDICARE
WI1427191881Medicaid
WIP01734884OtherRAILROAD MEDICARE
WI477950008Medicare PIN
WIK400121378Medicare PIN