Provider Demographics
NPI:1992533178
Name:HOLTZ, LAURA OSBORN (OD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:OSBORN
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICELA
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:354 23RD AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7820
Mailing Address - Country:US
Mailing Address - Phone:701-566-5390
Mailing Address - Fax:605-371-7199
Practice Address - Street 1:354 23RD AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-7820
Practice Address - Country:US
Practice Address - Phone:701-566-5390
Practice Address - Fax:605-371-7199
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist