Provider Demographics
NPI:1396900395
Name:HULSE, PAUL ANDERSON (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDERSON
Last Name:HULSE
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 1:9340 FENTON CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6520
Mailing Address - Country:US
Mailing Address - Phone:503-407-4253
Mailing Address - Fax:
Practice Address - Street 1:333 S ALLISON PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3129
Practice Address - Country:US
Practice Address - Phone:303-989-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007336152WV0400X
COOPT2703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy