Provider Demographics
NPI:1821386244
Name:PAO, HOLLY JO (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JO
Last Name:PAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2025 JUNIPERO SERRA BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3892
Mailing Address - Country:US
Mailing Address - Phone:650-994-3390
Mailing Address - Fax:
Practice Address - Street 1:1 SERRAMONTE CTR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2345
Practice Address - Country:US
Practice Address - Phone:650-994-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14208152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist