MEDICARE: WILLIAM C HOLCOMB OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618000064	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15702	OTHER		OPTIMA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	044496	OTHER		BLUE CROSS BLUE SHIELD
4	0883370001	OTHER	VA	CIGNA GOVERNMENT SERVICES

General Provider Information

NPI Number	:	1831373315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM C HOLCOMB OD PC

Provider Business Mailing Address
First Line	:	160 MT PLEASANT RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-4152
Country	:	US
Telephone Number	:	757-482-4022
Fax Number	:	757-482-9065

Provider Business Practice Location Address
First Line	:	160 MT PLEASANT RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-4152
Country	:	US
Telephone Number	:	757-482-4022
Fax Number	:	757-482-9065

Authorized Official
Title or Position	:	INSURANCE SPECIALIST
Name	:	MRS. LAURIE R SMITHDEAL
Credential	:
Telephone Number	:	757-482-4022

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	04/03/2017

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