Individual provider Active NPI

Marinda Dee Hofacre, O.D.

  • Optometrist
  • Chino Hills, CA
National Provider Identifier
1174689954
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11553T Issued in CA
Practice address
13111 Peyton Dr
Chino Hills, CA 91709-6002
Phone
(909) 628-0091
NPI assigned
Dec 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11553T CA Primary

Addresses

Primary practice location

13111 Peyton Dr
Chino Hills, CA 91709-6002

Mailing address

13111 Peyton Dr
Chino Hills, CA 91709-6002
Phone (909) 628-0091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11553TCAMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174689954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13111 PEYTON DR",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917096002",
            "telephone_number": "909-628-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13111 PEYTON DR",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917096002",
            "telephone_number": "909-628-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOFACRE",
        "first_name": "MARINDA",
        "middle_name": "DEE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11553T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.