Provider Demographics
NPI:1720461940
Name:OBOIKOVITZ, HOLLY (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:OBOIKOVITZ
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 1:179 N CHICAGO ST
Mailing Address - Street 2:APT 313
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-4126
Mailing Address - Country:US
Mailing Address - Phone:815-723-2020
Mailing Address - Fax:815-724-1505
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist