Provider Demographics
NPI:1699750927
Name:GREGORY, STACEY HOLDSWORTH (OD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:HOLDSWORTH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:E
Other - Last Name:HOLDSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2045 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5437
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1121152W00000X
CO2934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO025426OtherKAISER COMMERCIAL NUMBER
CO79227201Medicaid
CO025426OtherKAISER COMMERCIAL NUMBER
AZU89120Medicare UPIN