Provider Demographics
NPI:1801851571
Name:HOEFT, WAYNE W (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:W
Last Name:HOEFT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:907 N SAN FERNANDO BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4326
Mailing Address - Country:US
Mailing Address - Phone:818-846-9075
Mailing Address - Fax:818-846-9010
Practice Address - Street 1:907 N SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4326
Practice Address - Country:US
Practice Address - Phone:818-846-9075
Practice Address - Fax:818-846-9010
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP4256T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD005180Medicaid
CASD0042561Medicaid
CA1801851571OtherNPI
CA1114069390OtherFACILITY NPI
CA1801851571OtherNPI
CAGSD005180Medicaid
CASD0042561Medicaid