| Organization Name: | ELK RIVER EYE CLINIC, P.A. |
| NPI Number: | 1063457943 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY MARK HOFFARD (PRESIDENT) |
| Mailing Address: | 19022 Freeport Ave Nw Suite H Elk River |
| State: | MN US |
| Postal Code: | 553304767 |
| Phone Number: | 7634411055 |
| Fax Number: | 7634417024 |
| NPI Enumeration Date: | 06/17/2006 |
| NPI Last Update Date: | 08/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |