Provider Demographics
NPI:1558463588
Name:HOFFMAN, KAREN R (OD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:R
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 1:905 PARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4101
Mailing Address - Country:US
Mailing Address - Phone:904-264-1206
Mailing Address - Fax:904-264-3685
Practice Address - Street 1:905 PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4101
Practice Address - Country:US
Practice Address - Phone:904-264-1206
Practice Address - Fax:904-264-3685
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00768833OtherGROUP MEMBER PTAN
FL36025OtherBCBS
FL621322700Medicaid
FL592812237OtherGROUP TAX ID/ITIN
FLAC538XMedicare PIN