MEDICARE: HOLLY SALLOGA OD

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	130001277	DE
2	152W00000X	Optometrist	OE008544T	PA

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
2	DE1277	OTHER	DE	EYE MED INS CO
3	20389	OTHER	DE	MID ATLANTIC CHRISTIANA

General Provider Information

NPI Number	:	1447225024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY SALLOGA OD

Provider Business Mailing Address
First Line	:	494 CONCHESTER HWY
Second Line	:
City	:	ASTON
State	:	PA
Zip	:	19014-3129
Country	:	US
Telephone Number	:	610-859-8030
Fax Number	:	610-859-8030

Provider Business Practice Location Address
First Line	:	494 CONCHESTER HWY
Second Line	:
City	:	ASTON
State	:	PA
Zip	:	19014-3129
Country	:	US
Telephone Number	:	610-859-8030
Fax Number	:	610-859-8030

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	11/14/2016

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Directions to “ HOLLY SALLOGA OD” Practice Location

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