Provider Demographics
NPI:1568662765
Name:HOLMES, JULIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E 4TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-5103
Mailing Address - Country:US
Mailing Address - Phone:918-935-3500
Mailing Address - Fax:918-935-3501
Practice Address - Street 1:9 E 4TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-5103
Practice Address - Country:US
Practice Address - Phone:918-935-3500
Practice Address - Fax:918-935-3501
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200277960AMedicaid
OK701134Medicare PIN
OK200277960AMedicaid