Basic Information
| Provider Information | |||||||||
| NPI: | 1538221817 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLT EYE CARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 AURELIUS RD | ||||||||
| Address2: | SUITE 20 | ||||||||
| City: | HOLT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488421367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176993937 | ||||||||
| FaxNumber: | 5176994199 | ||||||||
| Practice Location | |||||||||
| Address1: | 2040 AURELIUS RD | ||||||||
| Address2: | SUITE 20 | ||||||||
| City: | HOLT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488421367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176993937 | ||||||||
| FaxNumber: | 5176994199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 11/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | GARZA | ||||||||
| AuthorizedOfficialFirstName: | GLORIA | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5176993937 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.