Basic Information
| Provider Information | |||||||||
| NPI: | 1558344804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 CONSULTANT PL | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277076320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194933668 | ||||||||
| FaxNumber: | 9194905594 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 N DUKE ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277041707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195952020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1076 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | MH5065739 | 01 | US DRUG ENFORCEMENT ADMIN | OTHER | MH5065739 | 01 | DEA US DEPT OF JUSTICE | OTHER | 0911H | 01 | NC | BCBS | OTHER |