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General NPI Number Information
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NPI Number | 1104811488
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Entity Type | Individual
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Provider Name | MARILYN KAY HOLM O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 240 W FRONT ST STE A
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City | PORT ANGELES
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State | WA
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Zip | 98362-2609
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Country | US
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Telephone | 360-452-7891
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Fax | 360-452-8087
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Provider Business Mailing Address
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Address Line | 240 W FRONT ST STE A
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City | PORT ANGELES
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State | WA
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Zip | 98362-2609
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Country | US
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Telephone | 360-452-7891
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 334
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1550
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3846
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD61684652
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License Number State | WA
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