MEDICARE: ROBERT L HOFFMAN OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18001590A&B	IN

General Provider Information

NPI Number	:	1134325574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L HOFFMAN OD PC

Provider Business Mailing Address
First Line	:	1703 CALUMET AVE
Second Line	:	SUITE B
City	:	WHITING
State	:	IN
Zip	:	46394-1414
Country	:	US
Telephone Number	:	219-659-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 CALUMET AVE
Second Line	:	SUITE B
City	:	WHITING
State	:	IN
Zip	:	46394-1414
Country	:	US
Telephone Number	:	219-659-1105
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT L HOFFMAN
Credential	:	OD PC
Telephone Number	:	219-659-1105

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	03/04/2010

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