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General NPI Number Information
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NPI Number | 1164660072
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Entity Type | Organization
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Legal Business Name | STEVEN D HOLMSTROM O D INC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 31722 RAILROAD CANYON RD
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City | CANYON LAKE
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State | CA
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Zip | 92587-9486
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Country | US
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Telephone | 951-244-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 31722 RAILROAD CANYON RD
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City | CANYON LAKE
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State | CA
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Zip | 92587-9486
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Country | US
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Telephone | 951-244-4444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN D HOLMSTROM
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Credential | O.D.
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Telephone | 951-244-4444
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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 | 11993
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License Number State | CA
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