Provider Demographics
NPI:1548353303
Name:HOVANDER, MICHAEL STERVEN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STERVEN
Last Name:HOVANDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E. HOLLY ST.
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-752-2020
Mailing Address - Fax:360-738-9741
Practice Address - Street 1:707 E. HOLLY ST.
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-752-2020
Practice Address - Fax:360-738-9741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL1488 TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2014892Medicaid
WAGAB09864Medicare PIN
WAGAB09865Medicare PIN
WA2014892Medicaid
WA1326130001Medicare NSC