MEDICARE: DR. DAVID CORBETT HOLLIMAN 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	2480	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007976624	OTHER	TN	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	208063482	OTHER	TN	UNITED
4	8805914	OTHER	TN	CIGNA
5	4142571	OTHER	TN	BLUE CROSS / BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649265299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CORBETT HOLLIMAN O.D.

Provider Business Mailing Address
First Line	:	1203 N EASTMAN RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3145
Country	:	US
Telephone Number	:	423-247-3321
Fax Number	:	423-247-3631

Provider Business Practice Location Address
First Line	:	1203 N EASTMAN RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3145
Country	:	US
Telephone Number	:	423-247-3321
Fax Number	:	423-247-3631

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/04/2010

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