1306896725 NPI number — DR. STEVEN LAWRENCE GLICK O.D.

Table of content: DR. STEVEN LAWRENCE GLICK O.D. (NPI 1306896725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306896725 NPI number — DR. STEVEN LAWRENCE GLICK O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLICK
Provider First Name:
STEVEN
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306896725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
353 HARRISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80206-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-377-3168
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 S POTOMAC ST
Provider Second Line Business Practice Location Address:
155
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-5455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-369-1020
Provider Business Practice Location Address Fax Number:
303-369-1022
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1089 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08010894 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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