Provider Demographics
NPI:1518961929
Name:HOFFMAN, COURTNEY GARDNER (OD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:GARDNER
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 1:2980 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7237
Mailing Address - Country:US
Mailing Address - Phone:870-972-5540
Mailing Address - Fax:870-972-9564
Practice Address - Street 1:2980 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7237
Practice Address - Country:US
Practice Address - Phone:870-972-5540
Practice Address - Fax:870-972-9564
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49885OtherAR BLUECROSS/BLUESHIELD
AR154306722Medicaid
AR49885Medicare ID - Type Unspecified
ARU80725Medicare UPIN