MEDICARE: FAMILY EYE CARE AND PEDIATRIC VISION CENTER, 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1871656926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYE CARE AND PEDIATRIC VISION CENTER, PLLC

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	:	CO-OWNER / PLLC MEMBER
Name	:	DR. DAVID CORBETT HOLLIMAN
Credential	:	OD
Telephone Number	:	423-247-3321

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	03/30/2010

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