Organization
DR HOLLIS L STAVN O.D. AN OPTOMETRY CORPORATION
Active
Other names
Dr. Hollis L. Stavn
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOLLIS LOREN STAVN O.D. (OWNER)
(707) 527-9137
Entity
Organization
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
6812 TLG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255618500
ANTHEM BLUE CROSS
CA
05
—
1255618500
—
CA
Enumeration date
11/14/2011
Last updated
06/20/2018
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