Provider Demographics
NPI:1902895907
Name:HOOVER, WILLIAM J (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:HOOVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:904 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3354
Mailing Address - Country:US
Mailing Address - Phone:970-945-6011
Mailing Address - Fax:970-945-5627
Practice Address - Street 1:904 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3354
Practice Address - Country:US
Practice Address - Phone:970-945-6011
Practice Address - Fax:970-945-5627
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0679620002Medicare NSC
COCOB5069Medicare PIN
COU0417Medicare UPIN