Provider Demographics
NPI:1023895596
Name:HOLM, MAKSIM ALEKSANDR (ABO)
Entity type:Individual
Prefix:MR
First Name:MAKSIM
Middle Name:ALEKSANDR
Last Name:HOLM
Suffix:
Gender:M
Credentials:ABO
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Other - Credentials:
Mailing Address - Street 1:2448 CHESAPEAKE SQUARE RING RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2173
Mailing Address - Country:US
Mailing Address - Phone:757-488-6916
Mailing Address - Fax:757-465-2030
Practice Address - Street 1:2448 CHESAPEAKE SQUARE RING RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2173
Practice Address - Country:US
Practice Address - Phone:757-488-6916
Practice Address - Fax:757-465-2030
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1101004397156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician