JACK LYNN HOLLINS (NPI# 1679570675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679570675 |
| Entity Type | Individual |
| Full Name | JACK LYNN HOLLINS |
| Credential | M.D. |
| Practice Address |
120 N Eagle Creek Dr Ste 500 Lexington KY 40509 |
| Mailing Address |
120 N Eagle Creek Dr Ste 500 Lexington KY 40509-1827 |
| Practice Telephone | 8592633900 |
| Practice Fax Number | 8592633757 |
| Mailing Telephone | 8592633900 |
| Mailing Fax Number | 8592633757 |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2019-08-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
17380 | KY | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | 17380 | KY | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
17380 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | TAX ID | 611246763 | 01 |
| KY | 64173800 | 05 | |
| KY | ANTHEM PROVIDER NUMBER | 000000048591 | 01 |
| OH | 0685503 | 05 | |
| IN | 300027596 | 05 | |
| WV | 1679570675 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2353 Alexandria Dr, Suite 210, Lexington, KY 40504 | 8592647700 | 8592647744 |
| Street Address |
120 N EAGLE CREEK DR STE 500 |
| City | LEXINGTON |
| State | KY |
| Zip Code | 40509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427054808 | Miguel A Busquets | Ophthalmology | 120 N Eagle Creek Dr Ste 500, Lexington, KY 40509-1802 | 2005-06-22 |
| 1548647928 | Osama Sabbagh | Ophthalmology | 120 N Eagle Creek Dr Ste 500, Lexington, KY 40509-1827 | 2015-05-05 |
| 1326304890 | Shivani Varakantam Reddy | Ophthalmology | 120 N Eagle Creek Dr Ste 500, Lexington, KY 40509-1802 | 2012-04-09 |
| 1174840920 | Stephen Gbejule Odaibo | Ophthalmology | 120 N Eagle Creek Dr Ste 500, Lexington, KY 40509 | 2010-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902453640 | Grace T. Hallak | Counselor | 513 Darby Creek Rd, Lexington, KY 40509 | 2019-08-19 |
| 1932755774 | Lexington-fayette Urban-county Health Department | Public Health or Welfare | 4801 Athens Boonesboro Rd, Lexington, KY 40509 | 2019-08-16 |
| 1497308266 | Discover You Counseling LLC | Social Worker | 513 Darby Creek Drive, Unit 56 D, Lexington, KY 40509 | 2019-07-22 |
| 1407323611 | Trevor Douglas Mchardy | Physician Assistant | 101 North Eagle Creek Drive, Lexington, KY 40509 | 2018-10-25 |
| 1114413184 | Megan Medrano | Dietitian, Registered | 163 Old Todds Rd Ste 115, Lexington, KY 40509 | 2018-07-02 |
| 1750884292 | Active Medical LLC | Durable Medical Equipment & Medical Supplies | 3470 Blazer Pkwy Ste 350, Lexington, KY 40509 | 2018-03-12 |
| 1699273599 | Frederick Douglas High School | Public Health or Welfare | 2000 Winchester Rd, Lexington, KY 40509 | 2018-01-25 |
| 1710409370 | Sleep Identity Pllc | Clinic/Center | 541 Darby Creek Road, Ste 190, Lexington, KY 40509 | 2017-07-14 |
| 1164956397 | Danielle Anderson | Family Medicine | 24 Fountain Court, Suite 225, Lexington, KY 40509 | 2017-04-14 |
| 1356891782 | Dawn Jones | Physician Assistant | 101 N Eagle Creek Dr, Ste 120, Lexington, KY 40509 | 2016-10-10 |
| Find all providers in zip 40509 | ||||
| Taxonomy Code | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.