Provider Demographics
NPI:1316421308
Name:HOLLY VISION CLINIC PC
Entity type:Organization
Organization Name:HOLLY VISION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-694-3652
Mailing Address - Street 1:12606 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2447
Mailing Address - Country:US
Mailing Address - Phone:810-694-3652
Mailing Address - Fax:
Practice Address - Street 1:1121 N SAGINAW ST STE 1
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1380
Practice Address - Country:US
Practice Address - Phone:248-382-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty