Healthcare Provider Details

I. General information

NPI: 1104121961
Provider Name (Legal Business Name): ROBERT A HOFFMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E BIDWELL ST SUITE 10
FOLSOM CA
95630-3315
US

IV. Provider business mailing address

705 E BIDWELL ST SUITE 10
FOLSOM CA
95630-3315
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-6211
  • Fax: 916-983-6608
Mailing address:
  • Phone: 916-983-6211
  • Fax: 916-983-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9263T
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT A HOFFMAN
Title or Position: OWNER
Credential: OD
Phone: 916-983-6211