Provider Demographics
NPI:1730563057
Name:HOLLISTER, JESSICA RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RENEE
Last Name:HOLLISTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:12916 CONAMAR DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2760
Practice Address - Country:US
Practice Address - Phone:301-733-4944
Practice Address - Fax:301-733-5225
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA2512152W00000X
PAOEG003093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist