Healthcare Provider Details

I. General information

NPI: 1902246291
Provider Name (Legal Business Name): STEVEN R HOLT OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15341 W WADDELL RD STE 106
SURPRISE AZ
85379-5169
US

IV. Provider business mailing address

15341 W WADDELL RD STE 106
SURPRISE AZ
85379-5169
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-7800
  • Fax: 623-544-5260
Mailing address:
  • Phone: 623-544-7800
  • Fax: 623-544-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number1305
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1305
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number1305
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1305
License Number StateAZ

VIII. Authorized Official

Name: MR. STEVEN ROBERT HOLT
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 623-824-2591