Healthcare Provider Details

I. General information

NPI: 1477586360
Provider Name (Legal Business Name): WILLIAM HUNGER HOLMES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 W CHESTERFIELD BLVD
SPRINGFIELD MO
65807-8650
US

IV. Provider business mailing address

1650 S ENTERPRISE AVE STE A100
SPRINGFIELD MO
65804-1840
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-7788
  • Fax: 417-889-7227
Mailing address:
  • Phone: 417-889-7788
  • Fax: 417-889-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO3174
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: