MEDICARE: DR. MELISSA MARLO HOLLIMAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2021	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6235685	OTHER	TN	CIGNA
2	7106484	OTHER	TN	AETNA
3	4142567	OTHER	TN	BLUE CROSS / BLUE SHIELD
4	208063482	OTHER	TN	UNITED
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043205693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA MARLO HOLLIMAN O.D.

Provider Business Mailing Address
First Line	:	1203 N EASTMAN RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3145
Country	:	US
Telephone Number	:	423-967-2683
Fax Number	:	423-247-3631

Provider Business Practice Location Address
First Line	:	1203 N EASTMAN RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3145
Country	:	US
Telephone Number	:	423-967-2683
Fax Number	:	423-247-3631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/19/2008

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