Provider Demographics
NPI:1912981176
Name:HOLMES, JULIA A (OD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1378
Mailing Address - Country:US
Mailing Address - Phone:517-337-0316
Mailing Address - Fax:517-337-1779
Practice Address - Street 1:1535 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4489
Practice Address - Country:US
Practice Address - Phone:989-772-3339
Practice Address - Fax:989-772-4846
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003709152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00174369OtherRAILROAD MEDICARE
MI200000005767OtherPHPMM
MI4901003709OtherSTATE LICENSE
MIU52246Medicare UPIN
MIP00174369OtherRAILROAD MEDICARE