Provider Demographics
NPI:1386637957
Name:HOLICKI OPTICAL INC
Entity Type:Organization
Organization Name:HOLICKI OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:HOLICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-279-6335
Mailing Address - Street 1:142 E CHICAGO RD
Mailing Address - Street 2:STE B
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036
Mailing Address - Country:US
Mailing Address - Phone:517-279-6335
Mailing Address - Fax:517-278-3393
Practice Address - Street 1:142 E CHICAGO RD
Practice Address - Street 2:STE B
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-279-6335
Practice Address - Fax:517-278-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004481152W00000X
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N88010OtherADVANTRA FREEDOM
MI900A210610OtherBLUE CROSS BLUE SHEILD OF MI
MI540A210570OtherBLUE CROSS BLUE SHEILD OF MICHIGAN
MI900A210610OtherBLUE CROSS BLUE SHEILD OF MI
MI4414910001Medicare NSC