Provider Demographics
NPI:1285848317
Name:RON W HOLLEY JR DO LLC
Entity Type:Organization
Organization Name:RON W HOLLEY JR DO LLC
Other - Org Name:HOLLEY VISION CATARACT & LASIK INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:918-493-5800
Mailing Address - Street 1:1323 E 71ST ST
Mailing Address - Street 2:STE 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:STE 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:2007-05-09
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty