Provider Demographics
NPI:1073027348
Name:HOLMBERG OPTOMETRIC LTD
Entity Type:Organization
Organization Name:HOLMBERG OPTOMETRIC LTD
Other - Org Name:GREENSPAN OPTOMETRIC ASSOCOIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-754-0080
Mailing Address - Street 1:366 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1758
Mailing Address - Country:US
Mailing Address - Phone:708-754-0080
Mailing Address - Fax:
Practice Address - Street 1:366 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1758
Practice Address - Country:US
Practice Address - Phone:708-754-0080
Practice Address - Fax:708-754-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-25
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-010888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty