Provider Demographics
NPI:1598759953
Name:HOLLENBAUGH, GERALD K (OD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:K
Last Name:HOLLENBAUGH
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 1:3122 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4415
Mailing Address - Country:US
Mailing Address - Phone:970-945-2020
Mailing Address - Fax:970-945-5630
Practice Address - Street 1:3122 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4415
Practice Address - Country:US
Practice Address - Phone:970-945-2020
Practice Address - Fax:970-945-5630
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72806575Medicaid
CO72806575Medicaid
800283Medicare ID - Type Unspecified