Provider Demographics
NPI:1669477725
Name:HOLLENBECK, TIFFANY JOY (OD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JOY
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:908 JEFFERSON ST
Practice Address - Street 2:STE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2433
Practice Address - Country:US
Practice Address - Phone:206-897-4774
Practice Address - Fax:763-546-8114
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3825TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1669477725Medicaid