Provider Demographics
NPI:1770221202
Name:HOLMES, JENNIFER NICOLE (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICOLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:CHLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD, MS
Mailing Address - Street 1:6182 FALLA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110
Mailing Address - Country:US
Mailing Address - Phone:216-410-2288
Mailing Address - Fax:
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist