Organization
RANDALL R HOLLOWAY OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL R HOLLOWAY OD (OWNER)
(620) 223-0850
Entity
Organization
Contact information
Practice address
4 S NATIONAL AVE, FORT SCOTT, KS 66701-1309
(620) 223-0850
(620) 223-2464
Mailing address
4 S NATIONAL AVE, FORT SCOTT, KS 66701-1309
(620) 223-0850
(620) 223-2464
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
KS11843
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100217910A
—
KS
Enumeration date
05/14/2008
Last updated
12/27/2012
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