Provider Demographics
NPI:1043205693
Name:HOLLIMAN, MELISSA MARLO (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARLO
Last Name:HOLLIMAN
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 1:1203 N EASTMAN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3145
Mailing Address - Country:US
Mailing Address - Phone:423-967-2683
Mailing Address - Fax:423-247-3631
Practice Address - Street 1:1203 N EASTMAN RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3145
Practice Address - Country:US
Practice Address - Phone:423-967-2683
Practice Address - Fax:423-247-3631
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6235685OtherCIGNA
TN7106484OtherAETNA
TN4142567OtherBLUE CROSS / BLUE SHIELD
TN208063482OtherUNITED
TN3945553Medicaid
VA010110190Medicaid
TN7106484OtherAETNA
U92437Medicare UPIN