Healthcare Provider Details

I. General information

NPI: 1124028097
Provider Name (Legal Business Name): KARMEN M HOLDINGHAUSEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 GRAVES MILL RD
FOREST VA
24551-3967
US

IV. Provider business mailing address

2010 BREMO RD STE 128A
RICHMOND VA
23226-2444
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-5600
  • Fax:
Mailing address:
  • Phone: 877-969-0392
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2528
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003082
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: