Provider Demographics
NPI:1962135616
Name:HOLLANDER, MITCHELL (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 N HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3311
Mailing Address - Country:US
Mailing Address - Phone:843-884-9224
Mailing Address - Fax:
Practice Address - Street 1:1481 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3311
Practice Address - Country:US
Practice Address - Phone:843-884-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC368156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician