MEDICARE: MRS. ASHLEY MARIE HOLODNAK L.O.

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	156FX1800X	Optician	1711	CT

General Provider Information

NPI Number	:	1881115657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY MARIE HOLODNAK L.O.

Provider Business Mailing Address
First Line	:	130 AMITY RD
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06515-1405
Country	:	US
Telephone Number	:	203-397-3878
Fax Number	:	203-397-9110

Provider Business Practice Location Address
First Line	:	130 AMITY ROAD
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06515-0651
Country	:	US
Telephone Number	:	203-397-3878
Fax Number	:	203-397-9110

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	07/03/2017

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