Provider Demographics
NPI:1447225024
Name:SALLOGA, HOLLY (OD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SALLOGA
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 1:494 CONCHESTER HWY
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-3129
Mailing Address - Country:US
Mailing Address - Phone:610-859-8030
Mailing Address - Fax:610-859-8030
Practice Address - Street 1:494 CONCHESTER HWY
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-3129
Practice Address - Country:US
Practice Address - Phone:610-859-8030
Practice Address - Fax:610-859-8030
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE130001277152W00000X
PAOE008544T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038423Medicaid
DEDE1277OtherEYE MED INS CO
DE20389OtherMID ATLANTIC CHRISTIANA
PA434974Medicare PIN
DE1000038423Medicaid
U94612Medicare UPIN