Provider Demographics
NPI:1255442646
Name:HOLLING, ROGER G (OD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:G
Last Name:HOLLING
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 1:1208 L ST
Mailing Address - Street 2:PO BOX 272
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-2016
Mailing Address - Country:US
Mailing Address - Phone:402-694-6114
Mailing Address - Fax:402-694-6134
Practice Address - Street 1:1208 L ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-2016
Practice Address - Country:US
Practice Address - Phone:402-694-6114
Practice Address - Fax:402-694-6134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE94436Medicare PIN
NET71403Medicare UPIN