Provider Demographics
NPI:1992866941
Name:KIKER, HOLLY ALLISON (OD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ALLISON
Last Name:KIKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:KRISTEN
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1134 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2452
Mailing Address - Country:US
Mailing Address - Phone:704-694-3618
Mailing Address - Fax:704-694-6446
Practice Address - Street 1:1134 HOLLY STREET
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170
Practice Address - Country:US
Practice Address - Phone:704-694-3618
Practice Address - Fax:704-694-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist