Provider Demographics
NPI:1790733384
Name:HOLLAND, KATHLEEN V (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:V
Last Name:HOLLAND
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 1:317 KIMBERWICKE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7106
Mailing Address - Country:US
Mailing Address - Phone:910-630-0836
Mailing Address - Fax:
Practice Address - Street 1:4601 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-2138
Practice Address - Country:US
Practice Address - Phone:910-488-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890904YMedicaid
NC2469674DMedicare ID - Type Unspecified
NCU56429Medicare UPIN