1518352699 NPI number — SIMPLE OPTICAL, INC.

Table of content: JUDITH F BOUNOUS M.D. (NPI 1053341917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518352699 NPI number — SIMPLE OPTICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMPLE OPTICAL, INC.
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:
GUNBARREL OPTOMETRY
Provider Other Organization Name Type Code:
3
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:
1518352699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6545 GUNPARK DR
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-3347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-530-1973
Provider Business Mailing Address Fax Number:
303-530-1973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6545 GUNPARK DR
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80301-3347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-530-1973
Provider Business Practice Location Address Fax Number:
720-638-1223
Provider Enumeration Date:
04/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WREN
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-530-1973

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1938 , 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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