Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1531 | KS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2218 | OK |
NPI | 1134294549 |
---|---|
Provider Name | Dr. Charles Heath Holland |
First Address | Oskaloosa, KS 66066-4203 |
Second Address | Oskaloosa, KS 66066-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 06/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134294549 | (05) | KS |
U73017 | (02) | KS |