Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 17380 | KY |
N | 207W00000X | Ophthalmologist | 17380 | KY |
Y | 207WX0107X | Retina Specialist | 17380 | KY |
NPI | 1679570675 |
---|---|
Provider Name | Jack Lynn Hollins |
First Address | Lexington, KY 40509-1827 |
Second Address | Lexington, KY 40509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000048591 | ANTHEM PROVIDER NUMBER (01) | KY |
0685503 | (05) | OH |
1679570675 | (05) | WV |
300027596 | (05) | IN |
611246763 | TAX ID (01) | KY |
64173800 | (05) | KY |
A98211 | (02) | KY |