Provider Demographics
NPI:1457918997
Name:HOLMAN, SAMANTHA LYNN (OD)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:LYNN
Other - Last Name:SHOBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14264 MOURNING DOVE LN APT 101
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-8736
Mailing Address - Country:US
Mailing Address - Phone:317-358-6675
Mailing Address - Fax:
Practice Address - Street 1:525 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1317
Practice Address - Country:US
Practice Address - Phone:317-565-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN18004175A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program