Provider Demographics
NPI:1942360276
Name:HOEFT, CRAIG WHITMER (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WHITMER
Last Name:HOEFT
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 1:12661 GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4748
Mailing Address - Country:US
Mailing Address - Phone:818-367-2171
Mailing Address - Fax:818-364-7197
Practice Address - Street 1:12661 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4748
Practice Address - Country:US
Practice Address - Phone:818-367-2171
Practice Address - Fax:818-364-7197
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8494 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD005180Medicaid
CAOP8494OtherSTATE LICENSE
CASD0084940Medicaid
CAT70268Medicare UPIN
CAGSD005180Medicaid
CAWY3240Medicare PIN