MEDICARE: DR. HOLLY C CONWAY 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	3527 T387	OH

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	34144150900	OTHER	OH	BWC

General Provider Information

NPI Number	:	1619977980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY C CONWAY OD

Provider Business Mailing Address
First Line	:	1275 GLEN DR
Second Line	:
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-8958
Country	:	US
Telephone Number	:	330-674-6121
Fax Number	:	330-674-7409

Provider Business Practice Location Address
First Line	:	1275 GLEN DR
Second Line	:
City	:	MILLERSBURG
State	:	OH
Zip	:	44654-8958
Country	:	US
Telephone Number	:	330-674-6121
Fax Number	:	330-674-7409

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/11/2008

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