Provider Demographics
NPI:1093723249
Name:HOLLEY VISION CATARACT & LASIK INSTITUTE
Entity Type:Organization
Organization Name:HOLLEY VISION CATARACT & LASIK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:918-493-5800
Mailing Address - Street 1:1323 E 71ST ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5045
Mailing Address - Country:US
Mailing Address - Phone:918-493-5800
Mailing Address - Fax:918-493-5819
Practice Address - Street 1:1323 E 71ST ST
Practice Address - Street 2:SUITE 220
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5045
Practice Address - Country:US
Practice Address - Phone:918-493-5800
Practice Address - Fax:918-493-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3856261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI 01047Medicare UPIN