Provider Demographics
NPI:1306987177
Name:HOLLAND, DOLORES G (OD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:G
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:G
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:9745 FALL CREEK RD
Mailing Address - Street 2:400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4728
Mailing Address - Country:US
Mailing Address - Phone:317-578-0202
Mailing Address - Fax:317-578-2696
Practice Address - Street 1:9745 FALL CREEK RD
Practice Address - Street 2:400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4728
Practice Address - Country:US
Practice Address - Phone:317-578-0202
Practice Address - Fax:317-578-2696
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002199B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200500Medicare ID - Type Unspecified
INY32220Medicare UPIN