Provider Demographics
NPI:1386014397
Name:JEFFREY B HOLLAND OD PC
Entity Type:Organization
Organization Name:JEFFREY B HOLLAND OD PC
Other - Org Name:COLLEGE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BOYACE
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-444-3092
Mailing Address - Street 1:1350 COLLEGE AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7389
Mailing Address - Country:US
Mailing Address - Phone:303-444-3092
Mailing Address - Fax:303-938-0572
Practice Address - Street 1:1350 COLLEGE AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7389
Practice Address - Country:US
Practice Address - Phone:303-444-3092
Practice Address - Fax:303-938-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO2298152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty