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General NPI Number Information
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NPI Number | 1124572805
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Entity Type | Individual
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Provider Name | DAVID JUSTIN HOLDGRAFER O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 170 E CORRAL AVE STE 1
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City | SOLDOTNA
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State | AK
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Zip | 99669-7548
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Country | US
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Telephone | 907-262-3168
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Fax | 888-220-2134
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Provider Business Mailing Address
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Address Line | 170 E CORRAL AVE STE 1
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City | SOLDOTNA
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State | AK
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Zip | 99669-7548
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Country | US
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Telephone | 907-262-3168
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Fax | 888-220-2134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 113618
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License Number State | AK
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