MEDICARE: DR. JILL PAULY HOLLER 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	5480	OH
2	152WL0500X	Low Vision Rehabilitation Optometrist	5480	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222201	OTHER	OH	EYEMED ID NUMBER

General Provider Information

NPI Number	:	1437295508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL PAULY HOLLER O.D.

Provider Business Mailing Address
First Line	:	5915 BEAR CREEK DR
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-9543
Country	:	US
Telephone Number	:	419-882-6531
Fax Number	:	419-882-6531

Provider Business Practice Location Address
First Line	:	5225 MONROE ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3139
Country	:	US
Telephone Number	:	419-843-3042
Fax Number	:	419-843-2432

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/11/2025

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