Healthcare Provider Details

I. General information

NPI: 1437295508
Provider Name (Legal Business Name): JILL PAULY HOLLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 MONROE ST
TOLEDO OH
43623-3139
US

IV. Provider business mailing address

5915 BEAR CREEK DR
SYLVANIA OH
43560-9543
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-3042
  • Fax: 419-843-2432
Mailing address:
  • Phone: 419-882-6531
  • Fax: 419-882-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5480
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: