Provider Demographics
NPI:1912976788
Name:HOLLAND, JOHN F (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:HOLLAND
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 1:629 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2221
Mailing Address - Country:US
Mailing Address - Phone:423-543-7376
Mailing Address - Fax:423-543-6604
Practice Address - Street 1:629 BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2221
Practice Address - Country:US
Practice Address - Phone:423-543-7376
Practice Address - Fax:423-543-6604
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD T812152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0197330001OtherMEDICARE
TN3594801Medicaid
T61210Medicare UPIN
TN0197330001OtherMEDICARE