Provider Demographics
NPI:1447483359
Name:HOLCOMB, CHRISTOPHER JUSTIN (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JUSTIN
Last Name:HOLCOMB
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 1:8410 W FLAGLER ST
Mailing Address - Street 2:201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2092
Mailing Address - Country:US
Mailing Address - Phone:305-220-7555
Mailing Address - Fax:305-220-6020
Practice Address - Street 1:8410 W FLAGLER ST
Practice Address - Street 2:201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2092
Practice Address - Country:US
Practice Address - Phone:305-220-7555
Practice Address - Fax:305-220-6020
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60102641152W00000X
FLOPC4902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013564100Medicaid