Provider Demographics
NPI:1902246291
Name:STEVEN R HOLT OD PLLC
Entity Type:Organization
Organization Name:STEVEN R HOLT OD PLLC
Other - Org Name:HOLT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-824-2591
Mailing Address - Street 1:15341 W WADDELL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5169
Mailing Address - Country:US
Mailing Address - Phone:623-544-7800
Mailing Address - Fax:623-544-5260
Practice Address - Street 1:15341 W WADDELL RD STE 106
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5169
Practice Address - Country:US
Practice Address - Phone:623-544-7800
Practice Address - Fax:623-544-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1305152W00000X, 152WC0802X, 152WS0006X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76926Medicare UPIN