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General NPI Number Information
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NPI Number | 1194237826
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Entity Type | Individual
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Provider Name | ALEXANDRIA PAIGE HOLMES OD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 612 E ELM ST
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City | REPUBLIC
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State | MO
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Zip | 65738
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Country | US
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Telephone | 417-732-5575
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Fax | 417-732-4245
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Provider Business Mailing Address
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Address Line | 3660 S COX AVE APT 3204
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City | SPRINGFIELD
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State | MO
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Zip | 65807-6969
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Country | US
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Telephone |
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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 | 2018021504
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License Number State | MO
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