Provider Demographics
NPI:1306966254
Name:HYNSON, HOLLY (OD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HYNSON
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 1:407 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-1223
Mailing Address - Country:US
Mailing Address - Phone:717-359-4800
Mailing Address - Fax:
Practice Address - Street 1:407 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1223
Practice Address - Country:US
Practice Address - Phone:717-359-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA0485OtherEYEMED
VAHY912116OtherHIGHMARK-CLARITY VISION
VAVA0485OtherEYEMED
VA320104903OtherEIN-NVA AND OTHER INSURAN
PA084007Medicare ID - Type Unspecified