Provider Demographics
NPI:1417936014
Name:HOLT, STEVEN R (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
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 1:15341 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 # 106
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-932-2020
Practice Address - Fax:623-932-2668
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4157680001Medicare NSC
AZU97431Medicare UPIN
AZ76926Medicare PIN