Provider Demographics
NPI:1588634521
Name:HOLT, JUSTIN C
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:C
Last Name:HOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7941
Mailing Address - Country:US
Mailing Address - Phone:530-891-1900
Mailing Address - Fax:530-895-1664
Practice Address - Street 1:2890 VENTURA ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3553
Practice Address - Country:US
Practice Address - Phone:530-223-2325
Practice Address - Fax:530-365-6471
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53458739934152W00000X
CA34578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU99504Medicare UPIN