Provider Demographics
NPI:1558328526
Name:HOLSER, PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:HOLSER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5258 PLAINFIELD AVE NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1047
Mailing Address - Country:US
Mailing Address - Phone:616-361-2020
Mailing Address - Fax:616-363-4355
Practice Address - Street 1:5258 PLAINFIELD AVE NE
Practice Address - Street 2:SUITE F
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1047
Practice Address - Country:US
Practice Address - Phone:616-361-2020
Practice Address - Fax:616-363-4355
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004245152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P10350Medicare PIN
MIV03793Medicare UPIN