Healthcare Provider Details

I. General information

NPI: 1760793251
Provider Name (Legal Business Name): ANDREW DAVID HOFFMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MAIN ST
HICKSVILLE OH
43526-1120
US

IV. Provider business mailing address

203 N MAIN ST
HICKSVILLE OH
43526-1120
US

V. Phone/Fax

Practice location:
  • Phone: 419-542-7741
  • Fax: 419-542-7742
Mailing address:
  • Phone: 419-542-7741
  • Fax: 419-542-7742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003633A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6006 T2921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: