Healthcare Provider Details

I. General information

NPI: 1962434886
Provider Name (Legal Business Name): SAM HOFFMANN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S MAIN ST
SHERIDAN WY
82801-4224
US

IV. Provider business mailing address

116 S MAIN ST
SHERIDAN WY
82801-4224
US

V. Phone/Fax

Practice location:
  • Phone: 307-675-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number272T
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: