Healthcare Provider Details

I. General information

NPI: 1013691484
Provider Name (Legal Business Name): JOEL ROBERT HOLMQUIST OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 E 24TH ST
FREMONT NE
68025-2446
US

IV. Provider business mailing address

16861 BROWNE ST
OMAHA NE
68116-3202
US

V. Phone/Fax

Practice location:
  • Phone: 402-704-6964
  • Fax:
Mailing address:
  • Phone: 308-214-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1615
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: