Healthcare Provider Details

I. General information

NPI: 1114069390
Provider Name (Legal Business Name): BURBANK FAMILY OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N SAN FERNANDO BLVD
BURBANK CA
91504-4326
US

IV. Provider business mailing address

907 N SAN FERNANDO BLVD
BURBANK CA
91504-4326
US

V. Phone/Fax

Practice location:
  • Phone: 818-846-9075
  • Fax: 818-846-9010
Mailing address:
  • Phone: 818-846-9075
  • Fax: 818-846-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT 8494T
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT 4256 TPA
License Number StateCA

VIII. Authorized Official

Name: DR. WAYNE W HOEFT
Title or Position: OPTOMETRIST
Credential:
Phone: 818-846-9075