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General NPI Number Information
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NPI Number | 1386809002
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Entity Type | Individual
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Provider Name | CHRISTOPHER GEORGE HOLSTEAD O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 2300 SOUTHLAKE MALL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6650
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Country | US
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Telephone | 219-738-5150
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Fax | 219-736-0427
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Provider Business Mailing Address
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Address Line | 9387 MONROE ST APT 424
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City | CROWN POINT
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State | IN
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Zip | 46307-6210
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Country | US
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Telephone | 617-233-5995
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003538A
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License Number State | IN
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