Healthcare Provider Details

I. General information

NPI: 1396900395
Provider Name (Legal Business Name): PAUL ANDERSON HULSE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S ALLISON PKWY
LAKEWOOD CO
80226-3129
US

IV. Provider business mailing address

9340 FENTON CT
WESTMINSTER CO
80031-6520
US

V. Phone/Fax

Practice location:
  • Phone: 303-989-2020
  • Fax:
Mailing address:
  • Phone: 503-407-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number007336
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT2703
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: