MEDICARE: DR. JOHN WILLIAM HOLLIER 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	000784	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235119264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILLIAM HOLLIER O.D.

Provider Business Mailing Address
First Line	:	6775 MOLLY VIEW PT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-2111
Country	:	US
Telephone Number	:	770-354-6412
Fax Number	:	770-781-5103

Provider Business Practice Location Address
First Line	:	178 BRACKETTS WAY
Second Line	:	SUITE 1
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-2984
Country	:	US
Telephone Number	:	706-745-2020
Fax Number	:	770-781-5103

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/23/2017

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