Provider Demographics
NPI:1093844342
Name:HOLMSTROM, STEVEN D (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:HOLMSTROM
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 1:31722 RAILROAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9486
Mailing Address - Country:US
Mailing Address - Phone:951-244-4444
Mailing Address - Fax:
Practice Address - Street 1:31722 RAILROAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9486
Practice Address - Country:US
Practice Address - Phone:951-244-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119930Medicare UPIN