Provider Demographics
NPI:1689728388
Name:HOVLAND, IRENE ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ELIZABETH
Last Name:HOVLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:ELIZABETH
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3925 OLD REDWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1719
Mailing Address - Country:US
Mailing Address - Phone:707-566-5222
Mailing Address - Fax:
Practice Address - Street 1:3925 OLD REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1719
Practice Address - Country:US
Practice Address - Phone:707-566-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist