Provider Demographics
NPI:1588408850
Name:HOELLEIN, MICAH (OD)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:HOELLEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KEMP PL E APT 313
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-8510
Mailing Address - Country:US
Mailing Address - Phone:605-228-7702
Mailing Address - Fax:
Practice Address - Street 1:1520 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-6824
Practice Address - Country:US
Practice Address - Phone:605-882-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist