Healthcare Provider Details

I. General information

NPI: 1346305737
Provider Name (Legal Business Name): MELISSA K HOVEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 12TH AVE E
ALEXANDRIA MN
56308
US

IV. Provider business mailing address

120-12TH AVE E
ALEXANDRIA MN
56308
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-4321
  • Fax: 320-763-6921
Mailing address:
  • Phone: 320-763-4321
  • Fax: 320-763-6921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2703
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: