Provider Demographics
NPI:1215590898
Name:HOLTHAUS, KATHLEEN NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:NICOLE
Last Name:HOLTHAUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3606 N 156TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2163
Mailing Address - Country:US
Mailing Address - Phone:402-205-0754
Mailing Address - Fax:
Practice Address - Street 1:3606 N 156TH ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2163
Practice Address - Country:US
Practice Address - Phone:402-205-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist