Provider Demographics
NPI:1851567689
Name:HOLLIDAY, JENNIFER JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JEAN
Last Name:HOLLIDAY
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 1:167 NORTHSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-6836
Mailing Address - Country:US
Mailing Address - Phone:985-690-6686
Mailing Address - Fax:
Practice Address - Street 1:167 NORTHSHORE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-6836
Practice Address - Country:US
Practice Address - Phone:985-690-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1564-596T152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program