Basic Information
| Provider Information | |||||||||
| NPI: | 1427259159 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOCTORS OPTICAL, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ONE HOUR OPTICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1685 S COLORADO BLVD | ||||||||
| Address2: | UNIT O | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037576747 | ||||||||
| FaxNumber: | 3037576897 | ||||||||
| Practice Location | |||||||||
| Address1: | 1685 S COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037576747 | ||||||||
| FaxNumber: | 3037576897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUCKNER | ||||||||
| AuthorizedOfficialFirstName: | DEANNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXEC ASST. | ||||||||
| AuthorizedOfficialTelephone: | 3037576747 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 156FX1800X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
ID Information
| ID | Type | State | Issuer | Description | 62220888 | 05 | CO | MEDICAID |