Provider Demographics
NPI:1184938516
Name:HISCOX, JAMIE HOLLIDAY (OD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:HOLLIDAY
Last Name:HISCOX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:HOLLIDAY
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8456 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4010
Mailing Address - Country:US
Mailing Address - Phone:520-370-1346
Mailing Address - Fax:520-886-7488
Practice Address - Street 1:7402 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1411
Practice Address - Country:US
Practice Address - Phone:520-885-2052
Practice Address - Fax:520-886-7488
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty