Healthcare Provider Details

I. General information

NPI: 1356317663
Provider Name (Legal Business Name): GEOFFREY S HOLLAND OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 WASHINGTON ST
EAST STROUDSBURG PA
18301-2819
US

IV. Provider business mailing address

116 WASHINGTON ST
EAST STROUDSBURG PA
18301-2819
US

V. Phone/Fax

Practice location:
  • Phone: 570-421-4141
  • Fax: 570-421-4141
Mailing address:
  • Phone: 570-421-4141
  • Fax: 570-421-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000976
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: