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General NPI Number Information
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NPI Number | 1336249580
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Entity Type | Individual
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Provider Name | JIMMY RAY HOLLIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 34301 HIGHWAY 43
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City | THOMASVILLE
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State | AL
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Zip | 36784-3341
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Country | US
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Telephone | 334-636-4097
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Fax | 334-636-1151
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Provider Business Mailing Address
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Address Line | 618 BLOEDEL AVE
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City | THOMASVILLE
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State | AL
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Zip | 36784-2758
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Country | US
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Telephone | 334-636-1375
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Fax | 334-636-1151
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S899TA476
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License Number State | AL
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