Provider Demographics
NPI:1699890186
Name:HOLMES, DEIRDRE (OD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DEIRDRE
Other - Middle Name:ESTELLE
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3464 PENTAGON PRK BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1790
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3464 PENTAGON PRK BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1790
Practice Address - Country:US
Practice Address - Phone:937-429-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4610-T1356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist