Provider Demographics
NPI:1619977980
Name:CONWAY, HOLLY C (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:C
Last Name:CONWAY
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 1:1275 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-8958
Mailing Address - Country:US
Mailing Address - Phone:330-674-6121
Mailing Address - Fax:330-674-7409
Practice Address - Street 1:1275 GLEN DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8958
Practice Address - Country:US
Practice Address - Phone:330-674-6121
Practice Address - Fax:330-674-7409
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3527 T387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468079Medicaid
OH34144150900OtherBWC
OH34144150900OtherBWC
OH0468079Medicaid