Healthcare Provider Details

I. General information

NPI: 1801851571
Provider Name (Legal Business Name): WAYNE W HOEFT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/10/2007
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 TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOP4256T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: