Healthcare Provider Details

I. General information

NPI: 1407166499
Provider Name (Legal Business Name): JOHN JAMES HOFFMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 PARK AVE #100
ORANGE PARK FL
32073-4101
US

IV. Provider business mailing address

1680 SOUTHSIDE BLVD STE 100
JACKSONVILLE FL
32216-1924
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-1206
  • Fax:
Mailing address:
  • Phone: 904-777-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC004586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: