MEDICARE: WILLIAM J. HOOVER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1359	CO

General Provider Information

NPI Number	:	1902895907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J. HOOVER O.D.

Provider Business Mailing Address
First Line	:	904 PITKIN AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3354
Country	:	US
Telephone Number	:	970-945-6011
Fax Number	:	970-945-5627

Provider Business Practice Location Address
First Line	:	904 PITKIN AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3354
Country	:	US
Telephone Number	:	970-945-6011
Fax Number	:	970-945-5627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/23/2010

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