Provider Demographics
NPI:1700038791
Name:HOLSTAD, MARCIA JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:JEAN
Last Name:HOLSTAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARCIA
Other - Middle Name:JEAN
Other - Last Name:HOLSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5958 ASHWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7110
Mailing Address - Country:US
Mailing Address - Phone:515-440-4610
Mailing Address - Fax:515-440-4611
Practice Address - Street 1:813 MAIN ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1450
Practice Address - Country:US
Practice Address - Phone:515-207-7400
Practice Address - Fax:515-478-1076
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU58457Medicare UPIN