Provider Demographics
NPI:1043291685
Name:HOLLIS, ROBERT A (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2627 WEST CUMBERLAND STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-272-3068
Mailing Address - Fax:717-272-1682
Practice Address - Street 1:2627 WEST CUMBERLAND STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-272-3068
Practice Address - Fax:717-272-1682
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist