Provider Demographics
NPI:1083792618
Name:HOLLOWAY, STEPHEN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-2021
Mailing Address - Country:US
Mailing Address - Phone:724-758-6338
Mailing Address - Fax:724-752-2020
Practice Address - Street 1:400 7TH ST
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-2021
Practice Address - Country:US
Practice Address - Phone:724-758-6338
Practice Address - Fax:724-752-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU96744Medicare UPIN
PA6309960001Medicare NSC