Provider Demographics
NPI:1992133219
Name:MOOSE, HOLLY ELIZABETH (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:MOOSE
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2200 HENDERSON RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-7327
Practice Address - Country:US
Practice Address - Phone:614-273-2020
Practice Address - Fax:614-273-4335
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6221152W00000X
OHOPT.006221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist