Provider Demographics
NPI:1831195890
Name:HOLLAS, CHARLES WADE (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WADE
Last Name:HOLLAS
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 1:18040 SATURN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-4500
Mailing Address - Country:US
Mailing Address - Phone:281-333-8600
Mailing Address - Fax:281-333-4800
Practice Address - Street 1:18040 SATURN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-4500
Practice Address - Country:US
Practice Address - Phone:281-333-8600
Practice Address - Fax:281-333-4800
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5863TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150442503Medicaid
TX150442504Medicaid
TX150442504Medicaid
TX8B5446Medicare ID - Type Unspecified
TX8F6933Medicare PIN