Provider Demographics
NPI:1720021199
Name:HOLLAND, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:HOLLAND
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 1:580 S LOOP RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3415
Mailing Address - Country:US
Mailing Address - Phone:513-569-3741
Mailing Address - Fax:513-569-3941
Practice Address - Street 1:580 S LOOP RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3415
Practice Address - Country:US
Practice Address - Phone:513-569-3741
Practice Address - Fax:513-569-3941
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077410207W00000X
KY35605207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4046569Medicaid
KY64004476Medicaid
000000075280OtherBCBS
OH180038905OtherRAILROAD MEDICARE
OH2152316Medicaid
NY01484326Medicaid
WV3810009070Medicaid
WI81958100Medicaid
KY180038906OtherRAILROAD MEDICARE
IN200259180Medicaid
OH180038905OtherRAILROAD MEDICARE
TN4046569Medicaid
KY0656001Medicare PIN