Provider Demographics
NPI:1710903562
Name:HOFER, REBECCA J (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:HOFER
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 1:414 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-2504
Mailing Address - Country:US
Mailing Address - Phone:320-251-8061
Mailing Address - Fax:
Practice Address - Street 1:414 GREAT OAK DR
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-2504
Practice Address - Country:US
Practice Address - Phone:320-251-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3021152W00000X
MNMN3021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN145H9HOOtherBCBS
MN135971OtherUCARE
MN55330SAOtherBCBS GROUP
MN913445100Medicaid
MNC04670OtherMEDICARE GROUP
MN2203443OtherMEDICA
MN989371048853OtherPREFERRED ONE