Provider Demographics
NPI:1740458926
Name:WILLIAM J. HOOVER
Entity type:Organization
Organization Name:WILLIAM J. HOOVER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-945-6011
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08001356Medicaid
CO08001356Medicaid
CO0679620002Medicare NSC