Holloway, Randall
Holloway, Randall is an sole proprietor health care provider with primary practice located at 4 S National Ave , Fort Scott KS 66701-1309. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Holloway, Randall can be contacted via phone (620) 223-0850.Contact Information
Primary practice address
4 S National Ave
Fort Scott KS 66701-1309
Phone: (620) 223-0850
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1184-3 | Kansas |
Profile Details
| NPI number | 1134221864 |
|---|---|
| LBN Legal business name | Holloway, Randall |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 2nd, 2006 |
| Last updated | Jan 5th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134221864 | NPPES |
| Kansas | MEDICAID | 100217910A | |
| Kansas | Other | 410008912 |
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