Provider Demographics
NPI:1881865376
Name:JM HOLDER
Entity Type:Organization
Organization Name:JM HOLDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-437-2154
Mailing Address - Street 1:104 ADAMS ST
Mailing Address - Street 2:STE F
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772-3790
Mailing Address - Country:US
Mailing Address - Phone:256-437-2154
Mailing Address - Fax:256-437-2155
Practice Address - Street 1:104 ADAMS ST
Practice Address - Street 2:STE F
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-3790
Practice Address - Country:US
Practice Address - Phone:256-437-2154
Practice Address - Fax:256-437-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0819580001Medicare NSC