Healthcare Provider Details

I. General information

NPI: 1679570675
Provider Name (Legal Business Name): JACK LYNN HOLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N EAGLE CREEK DR STE 500
LEXINGTON KY
40509
US

IV. Provider business mailing address

120 N EAGLE CREEK DR STE 500
LEXINGTON KY
40509-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-3900
  • Fax: 859-263-3757
Mailing address:
  • Phone: 859-263-3900
  • Fax: 859-263-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number17380
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17380
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number17380
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: