Provider Demographics
NPI:1356317663
Name:HOLLAND, GEOFFREY S (OD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:S
Last Name:HOLLAND
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 1:116 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2819
Mailing Address - Country:US
Mailing Address - Phone:570-421-4141
Mailing Address - Fax:570-421-4141
Practice Address - Street 1:116 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2819
Practice Address - Country:US
Practice Address - Phone:570-421-4141
Practice Address - Fax:570-421-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81105Medicare UPIN
PA039869PLLMedicare ID - Type Unspecified