Provider Demographics
NPI:1043285356
Name:HOVEN, LEE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LEE ANN
Middle Name:
Last Name:HOVEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 S. CAMINO DEL RIO
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-247-8762
Mailing Address - Fax:970-385-4496
Practice Address - Street 1:1165 S. CAMINO DEL RIO
Practice Address - Street 2:SUITE 100
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-247-8762
Practice Address - Fax:970-385-4496
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03714TG152W00000X
COCO2680152W00000X
TX3714TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0418113-04Medicaid
TX0418113-08Medicaid
TX0418113-12Medicaid
TX8A2352Medicare PIN
TX0418113-08Medicaid
TX0418113-04Medicaid
TX0418113-12Medicaid