MEDICARE: BURBANK FAMILY OPTOMETRY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	OPT 8494T	CA
2	152WL0500X	Low Vision Rehabilitation Optometrist	OPT 4256 TPA	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DE850A	OTHER	CA	MEDICARE PTAN (GROUP)
4	DF035Z	OTHER	CA	MEDICARE PTAN (INDIVIDUAL)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1801851571	OTHER	CA	PROVIDER NPI

General Provider Information

NPI Number	:	1114069390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURBANK FAMILY OPTOMETRY INC

Provider Business Mailing Address
First Line	:	907 N SAN FERNANDO BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-4326
Country	:	US
Telephone Number	:	818-846-9075
Fax Number	:	818-846-9010

Provider Business Practice Location Address
First Line	:	907 N SAN FERNANDO BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-4326
Country	:	US
Telephone Number	:	818-846-9075
Fax Number	:	818-846-9010

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. WAYNE W HOEFT
Credential	:
Telephone Number	:	818-846-9075

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/10/2012

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Directions to “BURBANK FAMILY OPTOMETRY INC ” Practice Location

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