Provider Demographics
NPI:1891208252
Name:HOLMES, SHAKERA (OD, MS)
Entity Type:Individual
Prefix:
First Name:SHAKERA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:SHAKERA
Other - Middle Name:
Other - Last Name:GUESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD, MS
Mailing Address - Street 1:2009 MANTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4327
Mailing Address - Country:US
Mailing Address - Phone:215-882-0083
Mailing Address - Fax:
Practice Address - Street 1:50 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1723
Practice Address - Country:US
Practice Address - Phone:610-667-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist