Healthcare Provider Details

I. General information

NPI: 1770557522
Provider Name (Legal Business Name): SUSAN A. HOLT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 HIGHWAY 17 N UNIT 5
NORTH MYRTLE BEACH SC
29582-2276
US

IV. Provider business mailing address

106 HARBOR OAKS DR
MYRTLE BEACH SC
29588-9364
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-2682
  • Fax:
Mailing address:
  • Phone: 843-325-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1258
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: