Provider Demographics
NPI:1831373315
Name:WILLIAM C HOLCOMB OD PC
Entity type:Organization
Organization Name:WILLIAM C HOLCOMB OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITHDEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-482-4022
Mailing Address - Street 1:160 MT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4152
Mailing Address - Country:US
Mailing Address - Phone:757-482-4022
Mailing Address - Fax:757-482-9065
Practice Address - Street 1:160 MT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4152
Practice Address - Country:US
Practice Address - Phone:757-482-4022
Practice Address - Fax:757-482-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15702OtherOPTIMA
VA009204016Medicaid
044496OtherBLUE CROSS BLUE SHIELD
VA0883370001OtherCIGNA GOVERNMENT SERVICES
VA009204016Medicaid
VA009204016Medicaid
VA0883370001OtherCIGNA GOVERNMENT SERVICES
15702OtherOPTIMA