Healthcare Provider Details

I. General information

NPI: 1447042916
Provider Name (Legal Business Name): HOLLY CANON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 DRISCOLL DR
RENO NV
89509-3013
US

IV. Provider business mailing address

2137 DRISCOLL DR
RENO NV
89509-3013
US

V. Phone/Fax

Practice location:
  • Phone: 775-771-0908
  • Fax: 775-771-0908
Mailing address:
  • Phone: 775-771-0908
  • Fax: 775-771-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: