Provider Demographics
NPI:1598831075
Name:HOLLAWAY, JOSEPH CLARK (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CLARK
Last Name:HOLLAWAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N SALISBURY BLVD
Mailing Address - Street 2:STE #K119
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7810
Mailing Address - Country:US
Mailing Address - Phone:410-334-3698
Mailing Address - Fax:
Practice Address - Street 1:2300 N SALISBURY BLVD
Practice Address - Street 2:STE #K119
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7810
Practice Address - Country:US
Practice Address - Phone:410-334-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2030152W00000X
SC1469152W00000X
GAOPT002368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist