Provider Demographics
NPI:1558344804
Name:HOFFMAN, KEITH R (OD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
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 1:14 CONSULTANT PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6320
Mailing Address - Country:US
Mailing Address - Phone:919-493-3668
Mailing Address - Fax:919-490-5594
Practice Address - Street 1:3500 N DUKE ST STE 1
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1707
Practice Address - Country:US
Practice Address - Phone:919-595-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0911HOtherBCBS
MH5065739OtherDEA US DEPT OF JUSTICE
NC0911HOtherBCBS
MH5065739OtherUS DRUG ENFORCEMENT ADMIN
NC0722320001Medicare NSC