Provider Demographics
NPI:1437487105
Name:HOLT, LORRI
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:
Last Name:HOLT
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 1:17764 COUNTY HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:MN
Mailing Address - Zip Code:56533-9508
Mailing Address - Country:US
Mailing Address - Phone:218-739-9244
Mailing Address - Fax:
Practice Address - Street 1:615 S MILL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2756
Practice Address - Country:US
Practice Address - Phone:218-998-2020
Practice Address - Fax:218-998-2098
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN135794156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician