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General NPI Number Information
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NPI Number | 1114069390
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Entity Type | Organization
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Legal Business Name | BURBANK FAMILY OPTOMETRY INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 907 N SAN FERNANDO BLVD
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City | BURBANK
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State | CA
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Zip | 91504-4326
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Country | US
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Telephone | 818-846-9075
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Fax | 818-846-9010
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Provider Business Mailing Address
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Address Line | 907 N SAN FERNANDO BLVD
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City | BURBANK
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State | CA
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Zip | 91504-4326
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Country | US
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Telephone | 818-846-9075
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Fax | 818-846-9010
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. WAYNE W HOEFT
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Credential |
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Telephone | 818-846-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPT 8494T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | OPT 4256 TPA
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License Number State | CA
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