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General NPI Number Information
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NPI Number | 1225340466
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Entity Type | Individual
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Provider Name | BLAKE HOFFMAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2010
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 2204 M ST
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City | BELLEVILLE
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State | KS
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Zip | 66935-2244
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Country | US
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Telephone | 402-469-8835
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 K ST
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City | BELLEVILLE
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State | KS
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Zip | 66935-2445
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Country | US
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Telephone | 402-469-8835
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1343
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002497
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1870
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License Number State | KS
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