Provider Demographics
NPI:1699751883
Name:JOHN C HOLDSWORTH PC
Entity type:Organization
Organization Name:JOHN C HOLDSWORTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLDSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-783-3100
Mailing Address - Street 1:275 BICENTENNIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1900
Mailing Address - Country:US
Mailing Address - Phone:413-783-3100
Mailing Address - Fax:413-782-7998
Practice Address - Street 1:275 BICENTENNIAL HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1900
Practice Address - Country:US
Practice Address - Phone:413-783-3100
Practice Address - Fax:413-782-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW20241OtherBLUE SHIELD OF MASSACHUSE
MA9718541Medicaid
0003776Medicare PIN
MA9718541Medicaid