Provider Demographics
NPI:1548415938
Name:HOLLIBAUGH, LINDA (ABOC, RDO)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HOLLIBAUGH
Suffix:
Gender:F
Credentials:ABOC, RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 HWY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-391-3111
Mailing Address - Fax:281-391-3110
Practice Address - Street 1:5805 HIGHWAY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1206
Practice Address - Country:US
Practice Address - Phone:281-391-3111
Practice Address - Fax:281-391-3110
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR4079156FX1800X
TX268156FX1800X
DC12713156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01-0858323OtherEIN