MEDICARE: DONALD A HOLLSTEN MD PLLC

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	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician		TX
2	207W00000X	Ophthalmology Physician		TX

General Provider Information

NPI Number	:	1588016299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD A HOLLSTEN MD PLLC

Provider Business Mailing Address
First Line	:	4114 POND HILL RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1273
Country	:	US
Telephone Number	:	210-616-0739
Fax Number	:	210-616-0972

Provider Business Practice Location Address
First Line	:	4114 POND HILL RD STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1273
Country	:	US
Telephone Number	:	210-616-0739
Fax Number	:	210-616-0972

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD A HOLLSTEN
Credential	:	MD
Telephone Number	:	210-616-0739

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	01/06/2020

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