Provider Demographics
NPI:1255493466
Name:HOLLINGSWORTH, JEFFREY K (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:HOLLINGSWORTH
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 1:2941 MOSS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4748
Mailing Address - Country:US
Mailing Address - Phone:972-562-5822
Mailing Address - Fax:
Practice Address - Street 1:2041 N REDBUD BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-8214
Practice Address - Country:US
Practice Address - Phone:972-562-8292
Practice Address - Fax:972-547-3932
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5407TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10226OtherSPECTERA PROVIDER NUMBER
TX146080001Medicaid
TX47710OtherDAVIS PROVIDER NUMBER
TX550206OtherNVA PROVIDER NUMBER
TX33837OtherAVESIS PROVIDER NUMBER
TXHO757799OtherCLARITY PROVIDER NUMBER
TXTX5407OtherEYEMED PROVIDER NUMBER
TX550206OtherNVA PROVIDER NUMBER
TX00092PMedicare PIN