Dr Hollis L Stavn O.D. an Optometry Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

6812 TLG Issued in CA

Legal business name

DR HOLLIS L STAVN O.D. AN OPTOMETRY CORPORATION

Doing business as

Dr. Hollis L. Stavn

Practice address

2305 Mendocino Ave
Ste B
Santa Rosa, CA 95403-3157

Phone

(707) 527-9137

Fax

(707) 545-9278

NPI assigned

Nov 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Hollis Loren Stavn, O.D.

Title

Owner

Phone

(707) 527-9137

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Hollis L. Stavn Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sandra Linn Peace, PSYD

  • Clinical Psychologist
  • Petaluma, CA
  • NPI 1952595985
  NPD (past)
• Shiroko Liles Sokitch, MD

  • General Practice Physician
  • Santa Rosa, CA
  • NPI 1235229006
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1255618500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 MENDOCINO AVE",
            "address_2": "STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033157",
            "telephone_number": "707-527-9137",
            "fax_number": "707-545-9278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 MENDOCINO AVE",
            "address_2": "STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033157",
            "telephone_number": "707-527-9137",
            "fax_number": "707-545-9278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR HOLLIS L STAVN O.D. AN OPTOMETRY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "STAVN",
        "authorized_official_first_name": "HOLLIS",
        "authorized_official_middle_name": "LOREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-527-9137",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6812 TLG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255618500",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "1255618500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Hollis L. Stavn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.