Provider Demographics
NPI:1144331596
Name:HOOVEN, MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HOOVEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2545
Mailing Address - Country:US
Mailing Address - Phone:716-681-4920
Mailing Address - Fax:
Practice Address - Street 1:3735 UNION RD
Practice Address - Street 2:CONSUMER SQUARE SUITE 100
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4200
Practice Address - Country:US
Practice Address - Phone:716-685-4563
Practice Address - Fax:716-681-6354
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT83132Medicare UPIN
NY070981Medicare ID - Type UnspecifiedMEDICARE