MEDICARE: GRAHAM HOLT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OP1100193	AR

General Provider Information

NPI Number	:	1033112446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAHAM HOLT O.D.

Provider Business Mailing Address
First Line	:	211 MCAULEY CT
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6314
Country	:	US
Telephone Number	:	501-624-0609
Fax Number	:	501-624-6191

Provider Business Practice Location Address
First Line	:	211 MCAULEY CT
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6314
Country	:	US
Telephone Number	:	501-624-0609
Fax Number	:	501-624-6191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/09/2007

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