Provider Demographics
NPI:1699835637
Name:HOLT, KERRY THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:THOMAS
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 1:10816 LOMA DE VIDA LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3780
Mailing Address - Country:US
Mailing Address - Phone:915-241-2030
Mailing Address - Fax:915-822-8282
Practice Address - Street 1:10710 GATEWAY BLVD N
Practice Address - Street 2:STE B-10
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-1739
Practice Address - Country:US
Practice Address - Phone:915-821-6800
Practice Address - Fax:915-822-8282
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5632TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81274QOtherBLUE CROSS
TXU73464Medicare UPIN
TX00150SMedicare ID - Type Unspecified