Provider Demographics
NPI:1831117977
Name:RICHARDS, HOLLY ALYCE (OD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ALYCE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ALYCE
Other - Last Name:MATTHYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:714 CONGRESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3428
Practice Address - Country:US
Practice Address - Phone:512-477-9000
Practice Address - Fax:512-477-9105
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6943TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82293QOtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
TX82293QOtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
TX8G9776Medicare ID - Type Unspecified