MEDICARE: C. JUSTIN HOLCOMB, OD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	OPC4902	FL
2	305S00000X	Point of Service	OD60102641	WA
3	305R00000X	Preferred Provider Organization	OD60102641	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023330370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C. JUSTIN HOLCOMB, OD, LLC

Provider Business Mailing Address
First Line	:	5952 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6814
Country	:	US
Telephone Number	:	305-220-7555
Fax Number	:	786-534-8633

Provider Business Practice Location Address
First Line	:	5952 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6814
Country	:	US
Telephone Number	:	305-220-7555
Fax Number	:	786-534-8633

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CHRISTOPHER JUSTIN HOLCOMB
Credential	:	OD
Telephone Number	:	305-785-1886

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	11/25/2025

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