Provider Demographics
NPI:1114913589
Name:HOLMES, DENIS R (OD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VILLAGE ROW UNIT 413
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-7507
Mailing Address - Country:US
Mailing Address - Phone:360-319-7680
Mailing Address - Fax:
Practice Address - Street 1:9770 DORCHESTER RD UNIT 101
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7541
Practice Address - Country:US
Practice Address - Phone:843-767-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-05-01
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
WA1594152W00000X
SC2308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA001446200OtherMEDICARE
WA410004982OtherRR MEDICARE
WA2008191Medicaid
WAT03170Medicare UPIN
WA001446201Medicare ID - Type Unspecified
WA2008191Medicaid