Provider Demographics
NPI:1568778777
Name:HOFFMANN, AMANDA B (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:B
Other - Last Name:MAGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 STANLEY STREET
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:715-261-8500
Mailing Address - Fax:715-261-8667
Practice Address - Street 1:3401 STANLEY ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1326
Practice Address - Country:US
Practice Address - Phone:715-261-8500
Practice Address - Fax:715-261-8667
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3190-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3190-35OtherMEDICAL LICENSE
WIK400140818OtherMEDICARE
WI100022615Medicaid