Provider Demographics
NPI:1568466381
Name:HOLMES, VICTOR A (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:133 W MOJAVE ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-7704
Mailing Address - Country:US
Mailing Address - Phone:760-446-3800
Mailing Address - Fax:760-446-3899
Practice Address - Street 1:1541 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2606
Practice Address - Country:US
Practice Address - Phone:760-446-3800
Practice Address - Fax:760-446-3899
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG69242207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0103OtherJOHN DEERE
G69242OtherIMG
CA00G692420Medicaid
636780OtherAHI HEALTH LINK
180009432OtherRAILROAD MEDICARE
180009432OtherRAILROAD MEDICARE
CADE376Medicare PIN
636780OtherAHI HEALTH LINK
G69242OtherIMG