Individual
CLIFFORD L HOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6435 NIEMAN RD, SHAWNEE, KS 66203-3325
(913) 631-6959
Mailing address
6435 NIEMAN RD, SHAWNEE, KS 66203-3325
(913) 631-6959
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1261-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100218370A
—
KS
01
—
13529011
BLUE CROSS BLUE SHIELD
KS
Enumeration date
06/16/2006
Last updated
11/08/2011
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