Provider Demographics
NPI:1447578877
Name:HOFFMAN, LAUREN ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ROSE
Last Name:HOFFMAN
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 1:704 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2128
Mailing Address - Country:US
Mailing Address - Phone:704-372-3870
Mailing Address - Fax:
Practice Address - Street 1:704 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2128
Practice Address - Country:US
Practice Address - Phone:704-372-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C31-TA-853152W00000X
390200000X
NC2223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
12281758OtherCAQH
NC5918088Medicaid
NC08591502OtherMEDICARE PTAN