Provider Demographics
NPI:1164570206
Name:HOLT, CHRISTOPHER K (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:HOLT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1773
Mailing Address - Country:US
Mailing Address - Phone:717-761-3011
Mailing Address - Fax:717-761-5347
Practice Address - Street 1:1857 CENTER STREET
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1773
Practice Address - Country:US
Practice Address - Phone:717-761-3011
Practice Address - Fax:717-761-5347
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7686016Medicaid
PA7686016Medicaid
PAU92208Medicare UPIN
PA686016Medicare PIN