Provider Demographics
NPI:1962788935
Name:HOLTE, RYAN J (LDO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:HOLTE
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 ASHWOOD DR
Mailing Address - Street 2:SUITE 131
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2465
Mailing Address - Country:US
Mailing Address - Phone:513-484-2895
Mailing Address - Fax:513-685-4575
Practice Address - Street 1:4700 ASHWOOD DR
Practice Address - Street 2:SUITE 131
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2465
Practice Address - Country:US
Practice Address - Phone:513-484-2895
Practice Address - Fax:513-685-4575
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS11499156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician