Basic Information
| Provider Information | |||||||||
| NPI: | 1881687432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORSTOT | ||||||||
| FirstName: | STEPHAN | ||||||||
| MiddleName: | LANCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8381 SOUTHPARK LN | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801204508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037300404 | ||||||||
| FaxNumber: | 3037306163 | ||||||||
| Practice Location | |||||||||
| Address1: | 8381 SOUTHPARK LN | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801204508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037300404 | ||||||||
| FaxNumber: | 3037306163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 20155 | CO | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180014204 | 01 | RAILROAD MEDICARE | OTHER | 920683020788 | 01 | BLOCK VISION EYE SPECIALI | OTHER | FOB4528 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 01201557 | 05 | CO | MEDICAID |