Healthcare Provider Details

I. General information

NPI: 1134433170
Provider Name (Legal Business Name): CRYSTAL L HOFFERT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 04/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43309 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-6221
US

IV. Provider business mailing address

43309 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-6221
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-2020
  • Fax: 727-938-5606
Mailing address:
  • Phone: 727-938-2020
  • Fax: 727-938-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010378
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: