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General NPI Number Information
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NPI Number | 1093874364
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Entity Type | Organization
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Legal Business Name | JAVEN D. HOLM OD PA
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 1210 EAST BLUE EARTH AVENUE
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City | FAIRMONT
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State | MN
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Zip | 56031-4441
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Country | US
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Telephone | 507-238-3363
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 EAST BLUE EARTH AVENUE
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City | FAIRMONT
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State | MN
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Zip | 56031-4441
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Country | US
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Telephone | 507-238-3363
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAVEN DELANO HOLM
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Credential | OD
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Telephone | 507-238-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | MN2192
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License Number State | MN
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