Provider Demographics
NPI:1346322328
Name:HOLT, RAE SH (OD)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:SH
Last Name:HOLT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98-151 PALI MOMI ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4300
Mailing Address - Country:US
Mailing Address - Phone:808-483-6439
Mailing Address - Fax:808-483-6087
Practice Address - Street 1:98-151 PALI MOMI ST
Practice Address - Street 2:SUITE 142
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4300
Practice Address - Country:US
Practice Address - Phone:808-483-6439
Practice Address - Fax:808-483-6087
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI502345Medicaid
HI00A0219640OtherHMSA
HI502345Medicaid
HI00A0219640OtherHMSA