Provider Demographics
NPI:1811139736
Name:HOLLAND EYE CARE,INC.
Entity type:Organization
Organization Name:HOLLAND EYE CARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:GIBBONS
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-578-0202
Mailing Address - Street 1:9745 FALL CREEK RD
Mailing Address - Street 2:SUITE400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4728
Mailing Address - Country:US
Mailing Address - Phone:317-578-0202
Mailing Address - Fax:317-578-2696
Practice Address - Street 1:9745 FALL CREEK RD
Practice Address - Street 2:SUITE400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4728
Practice Address - Country:US
Practice Address - Phone:317-578-0202
Practice Address - Fax:317-578-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002199B332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4589350001Medicare NSC
INM100033470Medicare PIN