Organization
ELK RIVER EYE CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY MARK HOFFARD O.D. (PRESIDENT)
(763) 441-1055
Entity
Organization
Contact information
Practice address
19022 FREEPORT AVE NW, SUITE H, ELK RIVER, MN 55330-4767
(763) 441-1055
(763) 441-7024
Mailing address
19022 FREEPORT AVE NW, SUITE H, ELK RIVER, MN 55330-4767
(763) 441-1055
(763) 441-7024
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
156FX1800X
Optician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115815
UCARE
MN
01
—
21-15856
MEDICA OPTICAL
MN
05
—
379314100
—
MN
01
—
52390HO
BCBS
MN
01
—
5C159EL
BCBS MATERIALS
MN
01
—
81961
HEALTH PARTNERS
MN
01
—
96458
PREFERRED ONE
MN
01
—
98-22038
MEDICA CLINIC NUMBER
MN
01
—
CJ6982
RAILROAD MEDICARE
MN
Enumeration date
06/17/2006
Last updated
08/06/2010
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