Provider Demographics
NPI:1811090087
Name:CHARLES J HOFER MD PC
Entity type:Organization
Organization Name:CHARLES J HOFER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-972-1101
Mailing Address - Street 1:13340 N 94TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4236
Mailing Address - Country:US
Mailing Address - Phone:623-972-1101
Mailing Address - Fax:623-933-2952
Practice Address - Street 1:13340 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4236
Practice Address - Country:US
Practice Address - Phone:623-972-1101
Practice Address - Fax:623-933-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10109207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty