Provider Demographics
NPI:1942640859
Name:ANDERSON, HOLLY (OD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ANDERSON
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 1:4875 WARD RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1942
Mailing Address - Country:US
Mailing Address - Phone:303-456-9456
Mailing Address - Fax:303-463-7560
Practice Address - Street 1:4875 WARD RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1942
Practice Address - Country:US
Practice Address - Phone:303-456-9456
Practice Address - Fax:303-463-7560
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0002991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist