Dementre Holmes, OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

2447I Issued in AZ

Practice address

11409 N 58TH Dr
Glendale, AZ 85304-3312

Phone

(480) 577-7096

Fax

(800) 869-4964

NPI assigned

Dec 16, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1821419979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11409 N 58TH DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853043312",
            "telephone_number": "480-577-7096",
            "fax_number": "800-869-4964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11409 N 58TH DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853043312",
            "telephone_number": "480-577-7096",
            "fax_number": "800-869-4964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 W Dunlap Ave",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850213527",
            "country_code": "US",
            "telephone_number": "480-577-7096",
            "fax_number": "800-869-4964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "DEMENTRE",
        "name_prefix": "Mr.",
        "credential": "OPTICIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-16",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "AZ",
            "license": "2447I",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holistic Healing Center LLC
• Samantha Marie Holland-Good, BCBA
• Marianna Holland, CNM
• Holliday B. Milby, PH.D.,P.C.
• Troy V Holloway, AUD
• Natalie Jean Holmgren, LCSW
• Cynthia Jean Holsen, WHNP RNC
• Cameron James Holshouser, PT, DPT
• Darian Michalle Holstad, SLPA
• McKinsey Holthaus, PA-C

• Optician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Optician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.