Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 714 | AZ |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 714 | AZ |
NPI | 1164484499 |
---|---|
Provider Name | Dr. Doyle D. Holle |
First Address | Tempe, AZ 85282-5877 |
Second Address | Tempe, AZ 85282-5877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T41743 | (02) | AZ |