Organization
JAVEN D. HOLM OD PA
Active
Other names
Family Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAVEN DELANO HOLM OD (OWNER)
(507) 238-3363
Entity
Organization
Contact information
Practice address
1210 EAST BLUE EARTH AVENUE, FAIRMONT, MN 56031-4441
(507) 238-3363
Mailing address
1210 EAST BLUE EARTH AVENUE, FAIRMONT, MN 56031-4441
(507) 238-3363
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MN2192
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039223500
—
MN
05
—
051651100
—
MN
01
—
1285630632
JAVEN HOLM OD NPI
MN
01
—
972N0FA
FEC GLASSES NUMBER
MN
01
—
972N8FA
DR HOLM BCBS #
MN
01
—
C03824
MEDICARE GROUP #
MN
Enumeration date
12/06/2006
Last updated
12/14/2010
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