Provider Demographics
NPI:1437295508
Name:HOLLER, JILL PAULY (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:PAULY
Last Name:HOLLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9543
Mailing Address - Country:US
Mailing Address - Phone:419-882-6531
Mailing Address - Fax:419-882-6531
Practice Address - Street 1:5225 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3139
Practice Address - Country:US
Practice Address - Phone:419-843-3042
Practice Address - Fax:419-843-2432
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5480152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH222201OtherEYEMED ID NUMBER
OHP00157473Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OHHO4146032Medicare ID - Type UnspecifiedVISION ASSOCIATES LOCATIO
OHHO4146031Medicare ID - Type UnspecifiedSIGHT CENTER LOCATION