Provider Demographics
NPI:1851519987
Name:HOLLANDER, SHAWN MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MITCHELL
Last Name:HOLLANDER
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 1:330 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3645
Mailing Address - Country:US
Mailing Address - Phone:727-799-1233
Mailing Address - Fax:727-669-9308
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3645
Practice Address - Country:US
Practice Address - Phone:727-799-1233
Practice Address - Fax:727-669-9308
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0783544-00Medicaid
FL19842Medicare ID - Type UnspecifiedMEDICARE PART B
FL0783544-00Medicaid