Provider Demographics
NPI:1366482473
Name:HOFFARD, GARY MARK (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARK
Last Name:HOFFARD
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:19022 FREEPORT AVE NW
Mailing Address - Street 2:SUITE H
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4767
Mailing Address - Country:US
Mailing Address - Phone:763-441-1055
Mailing Address - Fax:763-441-7024
Practice Address - Street 1:19022 FREEPORT AVE NW
Practice Address - Street 2:SUITE H
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4767
Practice Address - Country:US
Practice Address - Phone:763-441-1055
Practice Address - Fax:763-441-7024
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1555152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN181823600Medicaid
MN22-02701OtherMEDICA
MN410047337OtherRAILROAD MEDICARE
MNON399HOOtherBLUE CROSS BLUE SHIELD
MN0657001OtherPREFERRED ONE
MN115816OtherUCARE
MNHP17962OtherHEALTH PARTNERS
MN0657001OtherPREFERRED ONE
MNT65625Medicare UPIN