Provider Demographics
NPI:1962739912
Name:HOFELDT, KURT JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:JAMES
Last Name:HOFELDT
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 1:2355 YAKIMA CT
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3861
Mailing Address - Country:US
Mailing Address - Phone:636-359-2159
Mailing Address - Fax:
Practice Address - Street 1:3700 MARTIN WAY E
Practice Address - Street 2:SUITE 101
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5052
Practice Address - Country:US
Practice Address - Phone:360-456-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60102590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8892710Medicare UPIN