Provider Demographics
NPI:1821382714
Name:HOLICKI OPTICAL INC
Entity Type:Organization
Organization Name:HOLICKI OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOLCIKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-279-6335
Mailing Address - Street 1:142 E CHICAGO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-8449
Mailing Address - Country:US
Mailing Address - Phone:517-279-6335
Mailing Address - Fax:
Practice Address - Street 1:1202 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2343
Practice Address - Country:US
Practice Address - Phone:260-665-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000660241OtherANTHEM
IN4414910003Medicare NSC
INM100059297Medicare PIN