Individual provider Active NPI

David Corbett Holliman, O.D.

  • Optometrist
  • Kingsport, TN
National Provider Identifier
1649265299
Registry record updated Mar 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2480 Issued in TN
Practice address
1203 N Eastman Rd
Kingsport, TN 37664-3145
Phone
(423) 247-3321
Fax
(423) 247-3631
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2480 TN Primary

Addresses

Primary practice location

1203 N Eastman Rd
Kingsport, TN 37664-3145

Mailing address

1203 N Eastman Rd
Kingsport, TN 37664-3145
Phone (423) 247-3321

Other identifiers 6

IdentifierTypeStateIssuer
0007976624OtherTNAETNA
010110190MedicaidVA
208063482OtherTNUNITED
8805914OtherTNCIGNA
4142571OtherTNBLUE CROSS / BLUE SHIELD
3945902MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081001000730 TN Practitioner - Optometry 4486722659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1203 N Eastman Rd
Kingsport, TN 37664-3145
Phone (423) 247-3321

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2480TNMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Eye Care and Pediatric Vision Center, PLLC Optometrist CurrentSince Jun 1, 2008 Accepting new patients

Locations

1203 N Eastman Rd
Kingsport, TN 37664
Phone (423) 247-3321

Interoperability endpoints

  • Direct secure messaging: david.holliman@direct.revolutionehr.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267660800000",
    "number": "1649265299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 N EASTMAN RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376643145",
            "telephone_number": "423-247-3321",
            "fax_number": "423-247-3631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 N EASTMAN RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376643145",
            "telephone_number": "423-247-3321",
            "fax_number": "423-247-3631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIMAN",
        "first_name": "DAVID",
        "middle_name": "CORBETT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2010-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007976624",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010110190",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED",
            "identifier": "208063482",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8805914",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS / BLUE SHIELD",
            "identifier": "4142571",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3945902",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.