Provider Demographics
NPI:1962439752
Name:HOLMES JR., STEPHEN P (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:HOLMES JR.
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 TUPPER RD
Mailing Address - Street 2:P.O. BOX 537
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-1872
Mailing Address - Country:US
Mailing Address - Phone:508-888-3800
Mailing Address - Fax:508-888-3821
Practice Address - Street 1:68 TUPPER RD
Practice Address - Street 2:MERCHANT'S SQUARE
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-1872
Practice Address - Country:US
Practice Address - Phone:508-888-3800
Practice Address - Fax:508-888-3821
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0393649Medicaid
MAW15833OtherBLUE CROSS
MAW15833OtherBLUE CROSS
MA0393649Medicaid