Provider Demographics
NPI:1295791929
Name:HOLLEY, MARTA L (OD)
Entity type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:L
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:L
Other - Last Name:WALZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2770 N UNION BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1120
Mailing Address - Country:US
Mailing Address - Phone:719-471-2020
Mailing Address - Fax:719-633-7379
Practice Address - Street 1:2770 N UNION BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1120
Practice Address - Country:US
Practice Address - Phone:719-471-2020
Practice Address - Fax:719-633-7379
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91588251Medicaid
CO91588251Medicaid
COC7518Medicare PIN