Active NPI
Gary Mark Hoffard, O.D.
- Optometrist
- Elk River, MN
National Provider Identifier
1366482473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1555
- Practice address
- 19022 Freeport Ave NW
Suite H
Elk River, MN 55330-4767 - Phone
- (763) 441-1055
- Fax
- (763) 441-7024
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1555 | MN | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 1555 | MN | |
| Pediatric Optometrist | 152WP0200X | 1555 | MN | |
| Occupational Vision Optometrist | 152WX0102X | 1555 | MN |
Addresses
Primary practice location
19022 Freeport Ave NW
Suite H
Elk River, MN 55330-4767
Mailing address
19022 Freeport Ave NW
Suite H
Elk River, MN 55330-4767
Phone (763) 441-1055
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 181823600 | Medicaid | MN | |
| 22-02701 | Other | MN | MEDICA |
| 410047337 | Other | MN | RAILROAD MEDICARE |
| ON399HO | Other | MN | BLUE CROSS BLUE SHIELD |
| 0657001 | Other | MN | PREFERRED ONE |
| 115816 | Other | MN | UCARE |
| HP17962 | Other | MN | HEALTH PARTNERS |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1366482473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19022 FREEPORT AVE NW",
"address_2": "SUITE H",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553304767",
"telephone_number": "763-441-1055",
"fax_number": "763-441-7024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19022 FREEPORT AVE NW",
"address_2": "SUITE H",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553304767",
"telephone_number": "763-441-1055",
"fax_number": "763-441-7024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOFFARD",
"first_name": "GARY",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1555",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "MN",
"license": "1555",
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "MN",
"license": "1555",
"primary": false
},
{
"code": "152WX0102X",
"taxonomy_group": "",
"desc": "Optometrist, Occupational Vision",
"state": "MN",
"license": "1555",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "181823600",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "22-02701",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410047337",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "ON399HO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "0657001",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "115816",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP17962",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.