Provider Demographics
NPI:1164484499
Name:HOLLE, DOYLE D (OD)
Entity Type:Individual
Prefix:DR
First Name:DOYLE
Middle Name:D
Last Name:HOLLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4015 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5877
Mailing Address - Country:US
Mailing Address - Phone:480-345-0090
Mailing Address - Fax:480-345-7094
Practice Address - Street 1:4015 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 107
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5877
Practice Address - Country:US
Practice Address - Phone:480-345-0090
Practice Address - Fax:480-345-7094
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ714152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ41WCHSQ02Medicare PIN
AZT41743Medicare UPIN