Provider Demographics
NPI:1730288135
Name:HOLLAND, MALON PAUL (OD)
Entity Type:Individual
Prefix:
First Name:MALON
Middle Name:PAUL
Last Name:HOLLAND
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 1:414 PARKS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2440
Mailing Address - Country:US
Mailing Address - Phone:256-259-1614
Mailing Address - Fax:256-259-1614
Practice Address - Street 1:414 PARKS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2440
Practice Address - Country:US
Practice Address - Phone:256-259-1614
Practice Address - Fax:256-259-1614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS393TA238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0886600001Medicare NSC
ALT68943Medicare UPIN