=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528249596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN D HOLLINGSEAD CPO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2007
-----------------------------------------------------
Last Update Date | 11/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 S HALCYON RD STE. 104
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-3872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-481-9666
-----------------------------------------------------
Fax | 805-466-9504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8260 MORRO RD
-----------------------------------------------------
City | ATASCADERO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93422-3954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-466-1296
-----------------------------------------------------
Fax | 805-466-9504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------