Provider Demographics
NPI:1205146172
Name:HOLLIDAY OPTOMETRY, L.L.C
Entity type:Organization
Organization Name:HOLLIDAY OPTOMETRY, L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF RETAIL
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-327-6215
Mailing Address - Street 1:101 S LA CANADA DR STE 69
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2665
Mailing Address - Country:US
Mailing Address - Phone:520-625-5657
Mailing Address - Fax:
Practice Address - Street 1:101 S LA CANADA DR STE 69
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-2665
Practice Address - Country:US
Practice Address - Phone:520-625-5657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty