Provider Demographics
NPI:1588859649
Name:APPALACHIAN EYE CARE
Entity Type:Organization
Organization Name:APPALACHIAN EYE CARE
Other - Org Name:KENNY HOLLOWAY, OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-315-9446
Mailing Address - Street 1:8016 CUMMING HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9350
Mailing Address - Country:US
Mailing Address - Phone:678-315-9446
Mailing Address - Fax:
Practice Address - Street 1:8016 CUMMING HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9350
Practice Address - Country:US
Practice Address - Phone:678-315-9446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty