Healthcare Provider Details

I. General information

NPI: 1457285249
Provider Name (Legal Business Name): SAVANNAH HOLLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N MAIN ST
AUBURN IN
46706-1232
US

IV. Provider business mailing address

1212 N MAIN ST
AUBURN IN
46706-1232
US

V. Phone/Fax

Practice location:
  • Phone: 260-925-1916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004670A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: