1336221571 NPI number — COLORADO VISION SPECIALISTS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336221571 NPI number — COLORADO VISION SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO VISION SPECIALISTS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1336221571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W FLATIRON CIR
Provider Second Line Business Mailing Address:
SUITE 2052
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80021-8881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-887-6066
Provider Business Mailing Address Fax Number:
720-887-5866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 W FLATIRON CIR
Provider Second Line Business Practice Location Address:
SUITE 2052
Provider Business Practice Location Address City Name:
BROOMFIELD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80021-8881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-887-6066
Provider Business Practice Location Address Fax Number:
720-887-5866
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEOL
Authorized Official First Name:
GURPREET
Authorized Official Middle Name:
KAUR
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
720-887-6066

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1900 , 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)





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