Provider Demographics
NPI:1104892579
Name:HOFFMAN, ROBERT L (OD,PC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:OD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 CALUMET AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1414
Mailing Address - Country:US
Mailing Address - Phone:219-659-1105
Mailing Address - Fax:219-659-4855
Practice Address - Street 1:1703 CALUMET AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1414
Practice Address - Country:US
Practice Address - Phone:219-659-1105
Practice Address - Fax:219-659-4855
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001590A & B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN150450BOtherIN MEDICARE
410049344Medicare PIN
INU22738Medicare UPIN
IN0208960001Medicare NSC