Provider Demographics
NPI:1619045366
Name:HOVERMAN, STEPHEN AUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:AUSTIN
Last Name:HOVERMAN
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 1:3910 VILLA CT
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7422
Mailing Address - Country:US
Mailing Address - Phone:916-692-1740
Mailing Address - Fax:
Practice Address - Street 1:5900 SUNRISE BLVD
Practice Address - Street 2:SUNRISE MALL
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610
Practice Address - Country:US
Practice Address - Phone:916-961-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9138 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist