Healthcare Provider Details

I. General information

NPI: 1497231187
Provider Name (Legal Business Name): ELIZABETH T HOFMANN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH T POTVIN OD

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 05/27/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 WASHINGTON BLVD STE 101
STAMFORD CT
06902-2449
US

IV. Provider business mailing address

1351 WASHINGTON BLVD STE 101
STAMFORD CT
06902-2449
US

V. Phone/Fax

Practice location:
  • Phone: 203-327-5808
  • Fax: 203-352-5199
Mailing address:
  • Phone: 203-327-5808
  • Fax: 203-352-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3291
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: