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Individual

DR. RANDALL HOLLOWAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
4 S NATIONAL AVE, FORT SCOTT, KS 66701-1309
(620) 223-0850
Mailing address
4 S NATIONAL AVE, FORT SCOTT, KS 66701-1309
(620) 223-0850

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1184-3
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100217910A
KS
01
410008912
RAILROAD MEDICARE
KS
Enumeration date
09/02/2006
Last updated
01/05/2012
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