Provider Demographics
NPI:1548368954
Name:HOLLOWAY EYECARE PC
Entity type:Organization
Organization Name:HOLLOWAY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-569-5577
Mailing Address - Street 1:20905 GREENFIELD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5347
Mailing Address - Country:US
Mailing Address - Phone:248-569-5577
Mailing Address - Fax:248-569-6211
Practice Address - Street 1:20905 GREENFIELD RD STE 301
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5347
Practice Address - Country:US
Practice Address - Phone:248-569-5577
Practice Address - Fax:248-569-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI030365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104924743Medicaid
MI1806355592OtherBLUE CROSS
MI104924743Medicaid
MI1806355592OtherBLUE CROSS
MI0P36130Medicare PIN