Provider Demographics
NPI:1205896180
Name:HOEKSTRA, ALISSA ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:ANNE
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 SIERRA COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5932
Mailing Address - Country:US
Mailing Address - Phone:916-791-2526
Mailing Address - Fax:916-791-2561
Practice Address - Street 1:9260 SIERRA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5927
Practice Address - Country:US
Practice Address - Phone:916-791-2526
Practice Address - Fax:916-791-2561
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12344 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31135ZMedicare ID - Type UnspecifiedOPTOMTRIST