Healthcare Provider Details

I. General information

NPI: 1639177017
Provider Name (Legal Business Name): WILLIAM C HOLCOMB O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MT PLEASANT RD
CHESAPEAKE VA
23322-4152
US

IV. Provider business mailing address

160 MT PLEASANT RD
CHESAPEAKE VA
23322-4152
US

V. Phone/Fax

Practice location:
  • Phone: 757-482-4022
  • Fax: 757-482-9065
Mailing address:
  • Phone: 757-482-4022
  • Fax: 757-482-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0601000811
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: