Active NPI
Javen Delano Holm, OD
- Optometrist
- Fairmont, MN
National Provider Identifier
1285630632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- MN2192
- Practice address
- 1210 E Blue Earth Ave
Fairmont, MN 56031-4252 - Phone
- (507) 238-3363
- Fax
- (507) 235-3380
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | MN2192 | MN | Primary |
Addresses
Primary practice location
1210 E Blue Earth Ave
Fairmont, MN 56031-4252
Mailing address
1210 E Blue Earth Ave
Fairmont, MN 56031-4252
Phone (507) 238-3363
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05165110 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2192 | MN | MD | Psychologist |
| MN2192 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301961600000",
"number": "1285630632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 E BLUE EARTH AVE",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314252",
"telephone_number": "507-238-3363",
"fax_number": "507-235-3380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 E BLUE EARTH AVE",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314252",
"telephone_number": "507-238-3363",
"fax_number": "507-235-3380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLM",
"first_name": "JAVEN",
"middle_name": "DELANO",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2011-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "MN2192",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05165110",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.