Provider Demographics
NPI:1124028097
Name:HOLDINGHAUSEN, KARMEN M (OD)
Entity Type:Individual
Prefix:DR
First Name:KARMEN
Middle Name:M
Last Name:HOLDINGHAUSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 BREMO RD STE 128A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2444
Mailing Address - Country:US
Mailing Address - Phone:877-969-0392
Mailing Address - Fax:434-455-7172
Practice Address - Street 1:1825 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-3967
Practice Address - Country:US
Practice Address - Phone:434-385-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2528152W00000X
VA0618003082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03051719Medicaid
TN4092572OtherBCBS
TN3946305Medicaid
AR191619722Medicaid