MEDICARE: BREANNA K HOFFMANN O.D.

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	2068	AZ
2	152W00000X	Optometrist	374835	WI
3	152W00000X	Optometrist	3748-35	WI

General Provider Information

NPI Number	:	1356717011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA K HOFFMANN O.D.

Provider Business Mailing Address
First Line	:	353 N 8TH ST
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1515
Country	:	US
Telephone Number	:	715-748-2020
Fax Number	:	715-748-4565

Provider Business Practice Location Address
First Line	:	353 N 8TH ST
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1515
Country	:	US
Telephone Number	:	715-748-2020
Fax Number	:	715-748-4565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	10/09/2024

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