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General NPI Number Information
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NPI Number | 1205011780
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Entity Type | Organization
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Legal Business Name | HOLLADAY LASIK INSTITUTE
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 6802 MAPLERIDGE ST SUITE 200
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City | BELLAIRE
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State | TX
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Zip | 77401-3943
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Country | US
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Telephone | 713-668-7337
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Fax | 713-668-7336
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Provider Business Mailing Address
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Address Line | 6802 MAPLERIDGE ST SUITE 200
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City | BELLAIRE
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State | TX
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Zip | 77401-3943
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Country | US
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Telephone | 713-668-7337
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Fax | 713-668-7336
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK T. HOLLADAY
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Credential | M.D.
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Telephone | 713-668-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E2621
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License Number State | TX
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