Healthcare Provider Details

I. General information

NPI: 1033569033
Provider Name (Legal Business Name): TAYLOR HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 W TOURNAMENT TRL
WESTFIELD IN
46074-6212
US

IV. Provider business mailing address

1479 W TOURNAMENT TRL
WESTFIELD IN
46074-6212
US

V. Phone/Fax

Practice location:
  • Phone: 317-523-8784
  • Fax:
Mailing address:
  • Phone: 317-523-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003961A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: