Provider Demographics
NPI:1760793251
Name:HOFFMAN, ANDREW DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
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 1:203 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1120
Mailing Address - Country:US
Mailing Address - Phone:419-542-7741
Mailing Address - Fax:419-542-7742
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1120
Practice Address - Country:US
Practice Address - Phone:419-542-7741
Practice Address - Fax:419-542-7742
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003633A152W00000X
OH6006 T2921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000717638OtherANTHEM BLUE CROSS AND BLUE SHIELD
OH000000717638OtherANTHEM BLUE CROSS AND BLUE SHIELD