Healthcare Provider Details

I. General information

NPI: 1609846419
Provider Name (Legal Business Name): MARK HOVANDER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 UNIVERSITY WAY NE #101
SEATTLE WA
98105-6257
US

IV. Provider business mailing address

4115 UNIVERSITY WAY NE #101
SEATTLE WA
98105-6257
US

V. Phone/Fax

Practice location:
  • Phone: 206-633-2000
  • Fax: 206-633-4857
Mailing address:
  • Phone: 206-633-2000
  • Fax: 206-633-4857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1860TX
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: