Provider Demographics
NPI:1932425402
Name:BENNETT, HOLLY ADAMS (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ADAMS
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:SUZANNE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4170 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3606
Mailing Address - Country:US
Mailing Address - Phone:919-772-2020
Mailing Address - Fax:919-772-8818
Practice Address - Street 1:4170 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3606
Practice Address - Country:US
Practice Address - Phone:919-772-2020
Practice Address - Fax:919-772-8818
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2484639Medicare PIN
NCNC0290BMedicare PIN
NCNC0290AMedicare PIN