Provider Demographics
NPI:1780317115
Name:GROENHUYZEN, AMANDA (OD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GROENHUYZEN
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 1:7900 E UNION AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2736
Mailing Address - Country:US
Mailing Address - Phone:303-486-2020
Mailing Address - Fax:303-221-3434
Practice Address - Street 1:7900 E UNION AVE STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2736
Practice Address - Country:US
Practice Address - Phone:303-486-2020
Practice Address - Fax:303-221-3434
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty