Provider Demographics
NPI:1861589608
Name:HOFFMAN, LEON (OD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
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 1:113 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1006
Mailing Address - Country:US
Mailing Address - Phone:818-241-7719
Mailing Address - Fax:818-241-0507
Practice Address - Street 1:113 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1006
Practice Address - Country:US
Practice Address - Phone:818-241-7719
Practice Address - Fax:818-241-0507
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP5875T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0163870001Medicare NSC
CAOP5875Medicare PIN
CAT79385Medicare UPIN
CAP00125757Medicare PIN