Provider Demographics
NPI:1245504414
Name:JENNIFER HOLLIDAY LLC
Entity type:Organization
Organization Name:JENNIFER HOLLIDAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-690-6686
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:985-690-6648
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:985-690-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1564-596T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty