Provider Demographics
NPI:1063470532
Name:HOLTZMAN, GARY SILBERT (OD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SILBERT
Last Name:HOLTZMAN
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 1:1535 S KIPLING PKWY
Mailing Address - Street 2:UNIT C
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6258
Mailing Address - Country:US
Mailing Address - Phone:303-937-8655
Mailing Address - Fax:303-937-8675
Practice Address - Street 1:1535 S KIPLING PKWY
Practice Address - Street 2:UNIT C
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6258
Practice Address - Country:US
Practice Address - Phone:303-937-8655
Practice Address - Fax:303-937-8675
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U40516Medicare UPIN