=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790516888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA HOLLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2024
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8010 FROST ST STE 510
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-4284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-278-9900
-----------------------------------------------------
Fax | 858-278-9984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1747 CHALCEDONY ST APT 9
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92109-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 35807TLG
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------