Provider Demographics
NPI:1730115759
Name:HOFFMAN, JAMES ROBERT (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 PARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4101
Mailing Address - Country:US
Mailing Address - Phone:904-264-1206
Mailing Address - Fax:
Practice Address - Street 1:905 PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4101
Practice Address - Country:US
Practice Address - Phone:904-264-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0001656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1650227OtherUNITED HEALTHCARE
FL19642OtherBLUE CROSS BLUE SHIELD FL
FL4342800OtherAETNA
FL19642YMedicare PIN
FL4342800OtherAETNA
FL0853060001Medicare NSC