Healthcare Provider Details

I. General information

NPI: 1982980454
Provider Name (Legal Business Name): HOLLAWAY EYE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N SALISBURY BLVD STE K119
SALISBURY MD
21801-7810
US

IV. Provider business mailing address

2300 N SALISBURY BLVD STE K119
SALISBURY MD
21801-7810
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-3698
  • Fax: 443-260-1776
Mailing address:
  • Phone: 410-334-3698
  • Fax: 443-260-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2030
License Number StateMD

VIII. Authorized Official

Name: JOSEPH C. HOLLAWAY
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 410-334-3698