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NPI Code Detail

MEDICARE: STEVEN R HOLT OD PLLC

MEDICARE: STEVEN R HOLT OD PLLC
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
1302F00000XExclusive Provider Organization1305AZ
2152WC0802XCorneal and Contact Management Optometrist1305AZ
3152WS0006XSports Vision Optometrist1305AZ
4152W00000XOptometrist1305AZ

General Provider Information

NPI Number : 1902246291
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEVEN R HOLT OD PLLC
Provider Business Mailing Address
First Line : 15341 W WADDELL RD STE 106
Second Line :
City : SURPRISE
State : AZ
Zip : 85379-5169
Country : US
Telephone Number : 623-544-7800
Fax Number : 623-544-5260
Provider Business Practice Location Address
First Line : 15341 W WADDELL RD STE 106
Second Line :
City : SURPRISE
State : AZ
Zip : 85379-5169
Country : US
Telephone Number : 623-544-7800
Fax Number : 623-544-5260
Authorized Official
Title or Position : OPTOMETRIST/OWNER
Name : MR. STEVEN ROBERT HOLT
Credential : OD
Telephone Number : 623-824-2591
Provider Enumeration Date : 07/01/2013
Last Update Date : 10/10/2013

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