MEDICARE: DR. COURTNEY GARDNER HOFFMAN 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	2546	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49885	OTHER	AR	AR BLUECROSS/BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518961929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY GARDNER HOFFMAN O.D.

Provider Business Mailing Address
First Line	:	2980 BROWNS LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-7237
Country	:	US
Telephone Number	:	870-972-5540
Fax Number	:	870-972-9564

Provider Business Practice Location Address
First Line	:	2980 BROWNS LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-7237
Country	:	US
Telephone Number	:	870-972-5540
Fax Number	:	870-972-9564

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/11/2015

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