Provider Demographics
NPI:1508829227
Name:HOLLSTEN, DONALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:HOLLSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 POND HILL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1273
Mailing Address - Country:US
Mailing Address - Phone:210-616-0739
Mailing Address - Fax:210-616-0972
Practice Address - Street 1:4114 POND HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1273
Practice Address - Country:US
Practice Address - Phone:210-616-0739
Practice Address - Fax:210-616-0972
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2150207WX0200X, 207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1331308-02Medicaid
TX1331308-01Medicaid
TX133130805Medicaid
TX00N73KMedicare PIN
TX88Y398Medicare PIN
TX133130805Medicaid
TXF82998Medicare UPIN