Provider Demographics
NPI:1386773794
Name:WILLIAM H. HOLMES, INC.
Entity type:Organization
Organization Name:WILLIAM H. HOLMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HUNGER
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-889-7788
Mailing Address - Street 1:1650 S ENTERPRISE AVE
Mailing Address - Street 2:SUITE # A-100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1800
Mailing Address - Country:US
Mailing Address - Phone:417-889-7788
Mailing Address - Fax:417-889-7227
Practice Address - Street 1:1650 S ENTERPRISE AVE
Practice Address - Street 2:SUITE # A-100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1800
Practice Address - Country:US
Practice Address - Phone:417-889-7788
Practice Address - Fax:417-889-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108650OtherBLUE CROSS BLUE SHIELD
MO1271060001Medicare NSC
MOU51974Medicare UPIN