Holly Vision Source

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

HOLLY VISION SOURCE

Practice address

1121 N Saginaw St
1
Holly, MI 48442-1380

Phone

(810) 659-3135

NPI assigned

Apr 4, 2014

Organization subpart

Yes

Parent organization

FLUSHING VISION CLINIC, LLCAs reported in NPPES

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

Authorized official

Name

Ms. Rebecca Wallace

Title

Office Manager

Phone

(810) 659-3135

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Part of

Howard Foote OD

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Flushing Vision Clinic PC

  • Optometrist
  • Flushing, MI
  • NPI 1295782720
  NPPES parent name

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Flushing Vision Clinic PC

  • Optometrist
  • Flushing, MI
  • NPI 1295782720

  O20050719000948

  Same enrollment

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396569600000",
    "number": "1881012011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1379 FLUSHING RD",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484332262",
            "telephone_number": "810-659-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 N SAGINAW ST",
            "address_2": "1",
            "city": "HOLLY",
            "state": "MI",
            "postal_code": "484421380",
            "telephone_number": "810-659-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLY VISION SOURCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLUSHING VISION CLINIC, LLC",
        "enumeration_date": "2014-04-04",
        "last_updated": "2014-04-04",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "810-659-3135",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Foot & Ankle Specialists PLC
• Holly Pharmacy LLC
• Holly Pharmacy LLC
• Holly Urgent Care PLLC
• Holly Vision Clinic PC
• Hannah Leigh Houtz
• Timothy Lewis Hubbard
• Marie Elizabeth Hunter, D.D.S.
• Randy Lynn Hunter, D.D.S.
• Alexzandrea Israel, DOULA

• All providers in Holly, MI
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.