Provider Demographics
NPI:1316966823
Name:SPROUT, HOLLY LARAINE (OD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LARAINE
Last Name:SPROUT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:LARAINE
Other - Last Name:CURREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3025 CITY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-6232
Mailing Address - Country:US
Mailing Address - Phone:304-481-8437
Mailing Address - Fax:
Practice Address - Street 1:316 2ND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2919
Practice Address - Country:US
Practice Address - Phone:740-374-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1029-OD152W00000X
OH5542152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist