Provider Demographics
NPI:1770684425
Name:HUGDAHL, KIRSTIN D (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTIN
Middle Name:D
Last Name:HUGDAHL
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 1:1113 S ABILENE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1113 S ABILENE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5774
Practice Address - Country:US
Practice Address - Phone:303-755-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59909579Medicaid
CO59909579Medicaid
COU83117Medicare UPIN