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General NPI Number Information
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NPI Number | 1154591337
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Entity Type | Organization
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Legal Business Name | CLIFFORD L. HOLT, O.D.
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 6435 NIEMAN RD
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City | SHAWNEE
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State | KS
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Zip | 66203-3325
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Country | US
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Telephone | 913-631-6959
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Fax | 931-631-5930
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Provider Business Mailing Address
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Address Line | 6435 NIEMAN RD
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City | SHAWNEE
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State | KS
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Zip | 66203-3325
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Country | US
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Telephone | 913-631-6959
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Fax | 931-631-5930
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JULIE S HOLT
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Credential |
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Telephone | 913-631-6959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | KS12613
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License Number State | KS
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