Provider Demographics
NPI:1992282388
Name:HOLLEY, KATHRYN LYN (OD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LYN
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:5044 TENNYSON PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2953
Mailing Address - Country:US
Mailing Address - Phone:972-378-4104
Mailing Address - Fax:972-378-9094
Practice Address - Street 1:5425 W SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4236
Practice Address - Country:US
Practice Address - Phone:972-378-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist