Provider Demographics
NPI:1477586360
Name:HOLMES, WILLIAM HUNGER (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HUNGER
Last Name:HOLMES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 S ENTERPRISE AVE
Mailing Address - Street 2:STE A100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1840
Mailing Address - Country:US
Mailing Address - Phone:417-889-7788
Mailing Address - Fax:417-889-7227
Practice Address - Street 1:2142 W CHESTERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8650
Practice Address - Country:US
Practice Address - Phone:417-889-7788
Practice Address - Fax:417-889-7227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108650OtherMISSOURI BLUE CROSS
MO313888505Medicaid
MO1271060001Medicare NSC