MEDICARE: DR. STEPHEN ROBERT HOLLOWAY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG001165	PA

General Provider Information

NPI Number	:	1083792618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ROBERT HOLLOWAY O.D.

Provider Business Mailing Address
First Line	:	400 7TH ST
Second Line	:
City	:	ELLWOOD CITY
State	:	PA
Zip	:	16117-2021
Country	:	US
Telephone Number	:	724-758-6338
Fax Number	:	724-752-2020

Provider Business Practice Location Address
First Line	:	400 7TH ST
Second Line	:
City	:	ELLWOOD CITY
State	:	PA
Zip	:	16117-2021
Country	:	US
Telephone Number	:	724-758-6338
Fax Number	:	724-752-2020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/19/2012

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