Provider Demographics
NPI:1386809002
Name:HOLSTEAD, CHRISTOPHER GEORGE (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:HOLSTEAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9387 MONROE ST APT 424
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-6210
Mailing Address - Country:US
Mailing Address - Phone:617-233-5995
Mailing Address - Fax:
Practice Address - Street 1:2300 SOUTHLAKE MALL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6650
Practice Address - Country:US
Practice Address - Phone:219-738-5150
Practice Address - Fax:219-736-0427
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003538A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist