Basic Information
| Provider Information | |||||||||
| NPI: | 1740412121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEDROZA | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | MONIQUE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13142 GRANT CIR N | ||||||||
| Address2: | UNIT B | ||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802413498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202177644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 550 THORNTON PKWY | ||||||||
| Address2: | SUITE # 222 | ||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802292100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039203937 | ||||||||
| FaxNumber: | 7195420425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2737 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.