Provider Demographics
NPI:1134294549
Name:HOLLAND, CHARLES HEATH (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HEATH
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:HEATH
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1106 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066-4203
Mailing Address - Country:US
Mailing Address - Phone:785-863-2000
Mailing Address - Fax:786-863-3333
Practice Address - Street 1:1106 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-4203
Practice Address - Country:US
Practice Address - Phone:785-863-2000
Practice Address - Fax:786-863-3333
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2218152WC0802X
KS1531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1134294549Medicaid
KSU73017Medicare UPIN
KS1163780001Medicare NSC
KS1134294549Medicaid