1134374945 NPI number — CREATIVE EYEWEAR LLC

Table of content: (NPI 1134374945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134374945 NPI number — CREATIVE EYEWEAR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE EYEWEAR LLC
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:
ARVADA OPTICAL
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:
1134374945
Entity Type Code:
Organization
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:
8850 RALSTON RD
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
ARVADA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80002-2252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-421-8990
Provider Business Mailing Address Fax Number:
303-421-9402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8850 RALSTON RD
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
ARVADA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80002-2252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-421-8990
Provider Business Practice Location Address Fax Number:
303-421-9402
Provider Enumeration Date:
11/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MINNOTTE
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTICIAN
Authorized Official Telephone Number:
303-421-8990

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  CO2534 , 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: 1013027291 . This is a "NPI OPTOMETRIST" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CO2534 . This is a "COLORADO LISCENCE #" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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