Provider Demographics
NPI:1619010899
Name:HOLDEN, THOMAS EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:HOLDEN
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 1:1545 W 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6510
Mailing Address - Country:US
Mailing Address - Phone:805-382-2020
Mailing Address - Fax:805-985-1448
Practice Address - Street 1:1545 W 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6510
Practice Address - Country:US
Practice Address - Phone:805-382-2020
Practice Address - Fax:805-985-1448
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8495T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8495TOtherSTATE OPTOMETRIC LICENSE
CASD0084950Medicaid
T70269Medicare UPIN
CASD0084950Medicaid