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General NPI Number Information
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NPI Number | 1902246291
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Entity Type | Organization
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Legal Business Name | STEVEN R HOLT OD PLLC
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 10/10/2013
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Provider Practice Location Address
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Address Line | 15341 W WADDELL RD STE 106
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City | SURPRISE
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State | AZ
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Zip | 85379-5169
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Country | US
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Telephone | 623-544-7800
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Fax | 623-544-5260
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Provider Business Mailing Address
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Address Line | 15341 W WADDELL RD STE 106
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City | SURPRISE
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State | AZ
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Zip | 85379-5169
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Country | US
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Telephone | 623-544-7800
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Fax | 623-544-5260
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | MR. STEVEN ROBERT HOLT
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Credential | OD
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Telephone | 623-824-2591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 1305
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1305
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 1305
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1305
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License Number State | AZ
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