MEDICARE: DR. STEVEN D HOLMSTROM 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	11993	CA

General Provider Information

NPI Number	:	1093844342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN D HOLMSTROM O.D.

Provider Business Mailing Address
First Line	:	31722 RAILROAD CANYON RD
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9486
Country	:	US
Telephone Number	:	951-244-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	31722 RAILROAD CANYON RD
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9486
Country	:	US
Telephone Number	:	951-244-4444
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	02/28/2009

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