Provider Demographics
NPI:1619973310
Name:HOLTZMAN, STEVEN MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:HOLTZMAN
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 1:132 CENTRAL ST
Mailing Address - Street 2:STE 101
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2422
Mailing Address - Country:US
Mailing Address - Phone:508-543-9215
Mailing Address - Fax:508-543-9067
Practice Address - Street 1:132 CENTRAL ST
Practice Address - Street 2:STE 101
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2422
Practice Address - Country:US
Practice Address - Phone:508-543-9215
Practice Address - Fax:508-543-9067
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353604Medicaid
MA0353604Medicaid