Healthcare Provider Details

I. General information

NPI: 1740774264
Provider Name (Legal Business Name): MARK ANDREW HOFFMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 NE NORTHGATE WAY
SEATTLE WA
98125-7312
US

IV. Provider business mailing address

844 NE NORTHGATE WAY
SEATTLE WA
98125-7312
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-2162
  • Fax: 206-367-2125
Mailing address:
  • Phone: 206-367-2162
  • Fax: 206-367-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60862206
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: