Individual
DR. HOLLY RENEE BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1502 CUMBERLAND AVE, MIDDLESBORO, KY 40965-1223
(606) 248-0932
(606) 248-1384
Mailing address
1502 CUMBERLAND AVE, MIDDLESBORO, KY 40965-1223
(606) 248-0932
(606) 248-1384
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1673DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000492097
ANTHEM PIN NUMBER
KY
05
—
010332605
—
VA
01
—
1231987
CHA PROVIDER NUMBER
—
01
—
134506
VISION CARE PIN NUMBER
—
01
—
1673DT
STATE LICENSE NUMBER
KY
Enumeration date
07/27/2006
Last updated
07/16/2016
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