MEDICARE: DR. STEVEN R HOLT OD

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	152W00000X	Optometrist	1305	AZ

General Provider Information

NPI Number	:	1417936014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN R HOLT OD

Provider Business Mailing Address
First Line	:	15341 W WADDELL RD STE 106
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-5169
Country	:	US
Telephone Number	:	623-544-7800
Fax Number	:	623-544-5260

Provider Business Practice Location Address
First Line	:	15341 W WADDELL RD # 106
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379
Country	:	US
Telephone Number	:	623-932-2020
Fax Number	:	623-932-2668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	12/11/2013

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