Provider Demographics
NPI:1033296892
Name:MCLAIN, HOLLY ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANNE
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11768 W 146TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8412
Mailing Address - Country:US
Mailing Address - Phone:913-897-6975
Mailing Address - Fax:
Practice Address - Street 1:12200 BLUE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2639
Practice Address - Country:US
Practice Address - Phone:913-498-8690
Practice Address - Fax:913-529-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U34760Medicare UPIN
0000482Medicare ID - Type Unspecified