DR. HOLLIS LOREN STAVN (O.D.) – Optometrist, NPI 1194728527
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,909 OPTOMETRY in CA
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Provider Addresses for DR. HOLLIS LOREN STAVN (O.D.)
Fountaingrove Dentistry, 2305, Mendocino Avenue, Santa Rosa, Sonoma County, California, 95404, United States
STE B
SANTA ROSA, CA 954033157
Phone: (707) 527-9137
Fax: (707) 545-9278
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $71.
Total Amount is formed as General ($71) + Research ($0) + Ownership ($0) = $71.
Last reported payment date: 2024-09-25 • Largest payer in this snapshot: RxSight Inc ($50).
Total Amount
$71
General + Research + Ownership
Payments
2
Total payment records
General Amount
$71
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-25
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| RxSight Inc | $50 |
| Bausch & Lomb Americas Inc. | $22 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2011-11-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20111122000250 | I | Optometry | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 92014 | Established patient complete exam of visual system | 98 | 97 | $0 |
| 92004 | New patient complete exam of visual system | 45 | 45 | $0 |
Insurance plans in this area (ZIP 95403)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| O P T O M E T R Y | CA | |
| - | CA | |
| O P H T H A L M O L O G Y | CA | |
| O P H T H A L M O L O G Y | CA | |
| O P H T H A L M O L O G Y | CA | |
| O P H T H A L M O L O G Y | CA | |
| - | CA | |
| A N E S T H E S I O L O G Y | CA | |
| O P H T H A L M O L O G Y | CA | |
| O P H T H A L M O L O G Y | CA |
Reviews
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