Basic Information
| Provider Information | |||||||||
| NPI: | 1386638849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | BOWLIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 S CHIPLEY FORD RD | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286258121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048760572 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 646 HARTNESS RD | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286773423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048724108 | ||||||||
| FaxNumber: | 7048736517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 21046 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 20096066 | 01 | SC | SELECT HEALTH OF SC | OTHER | 772549 | 01 | SC | WELLCARE | OTHER | 8943094 | 05 | NC | MEDICAID | 01151985 | 01 | SC | AMERIGROUP COMMUNITY CARE | OTHER | 4223147 | 01 | NC | AETNA | OTHER | Q21046 | 05 | SC | MEDICAID | 332189 | 01 | NC | WELLPATH | OTHER | P00294329 | 01 | SC | RAILROAD MEDICARE | OTHER | Q21046 | 01 | SC | MEDICAID | OTHER | 1221507 | 01 | NC | UNITED HEALTHCARE | OTHER | 43094 | 01 | NC | BCBSNC | OTHER | 81895 | 01 | SC | CHC CARES OF SC | OTHER |