Provider Demographics
NPI:1720150865
Name:HOFFMAN, PAUL ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALLEN
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:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-1830
Mailing Address - Country:US
Mailing Address - Phone:740-450-2733
Mailing Address - Fax:740-450-8043
Practice Address - Street 1:2540 MAYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7561
Practice Address - Country:US
Practice Address - Phone:740-450-2733
Practice Address - Fax:740-450-8043
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3125T1053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340465Medicaid
OH0340465Medicaid
OH0218390001Medicare NSC
OHHO0442081Medicare PIN
OH410026366Medicare PIN