Provider Demographics
NPI:1316519986
Name:HAAGENSTAD, JULIE (COMT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HAAGENSTAD
Suffix:
Gender:F
Credentials:COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 WIND RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3185
Mailing Address - Country:US
Mailing Address - Phone:970-672-7322
Mailing Address - Fax:
Practice Address - Street 1:424 WIND RIVER DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3185
Practice Address - Country:US
Practice Address - Phone:970-672-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
210239156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic