MEDICARE: CHRISTOPHER JUSTIN HOLCOMB OD

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	OD60102641	WA
2	152W00000X	Optometrist	OPC4902	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447483359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER JUSTIN HOLCOMB OD

Provider Business Mailing Address
First Line	:	5952 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6814
Country	:	US
Telephone Number	:	786-534-8933
Fax Number	:	786-534-8633

Provider Business Practice Location Address
First Line	:	5952 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6814
Country	:	US
Telephone Number	:	786-534-8933
Fax Number	:	786-534-8633

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	12/04/2025

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