Provider Demographics
NPI:1073015350
Name:HOLLY ANDERSON OPTOMETRY
Entity Type:Organization
Organization Name:HOLLY ANDERSON OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-514-6028
Mailing Address - Street 1:3290 S NEWCOMBE ST UNIT 18206
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-6714
Mailing Address - Country:US
Mailing Address - Phone:505-514-6028
Mailing Address - Fax:
Practice Address - Street 1:14676 DELAWARE ST UNIT 400
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9184
Practice Address - Country:US
Practice Address - Phone:720-405-2020
Practice Address - Fax:720-634-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty