Individual
DR. HOLLIS LOREN STAVN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2305 MENDOCINO AVE, STE B, SANTA ROSA, CA 95403-3157
(707) 527-9137
(707) 545-9278
Mailing address
2305 MENDOCINO AVE, STE B, SANTA ROSA, CA 95403-3157
(707) 527-9137
(707) 545-9278
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6812T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45719
SAGEGUARD
CA
05
—
SD0068121
—
CA
Enumeration date
05/31/2005
Last updated
12/20/2012
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