MEDICARE: MICHAEL HOLLAND

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	1365	NC

General Provider Information

NPI Number	:	1083728752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HOLLAND

Provider Business Mailing Address
First Line	:	603 NEW BERN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-1513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 NEW BERN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27601-1513
Country	:	US
Telephone Number	:	919-828-9085
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/26/2007

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