Provider Demographics
NPI:1285453613
Name:HOLDER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 ALTAMONT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-2914
Mailing Address - Country:US
Mailing Address - Phone:518-355-6017
Mailing Address - Fax:518-355-6047
Practice Address - Street 1:1320 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-2924
Practice Address - Country:US
Practice Address - Phone:518-355-6017
Practice Address - Fax:518-355-6047
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07996-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician