Provider Demographics
NPI:1154474187
Name:POLLARD, KEVIN C (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:POLLARD
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 XAVIER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1024
Mailing Address - Country:US
Mailing Address - Phone:303-446-8688
Mailing Address - Fax:
Practice Address - Street 1:1516 XAVIER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1024
Practice Address - Country:US
Practice Address - Phone:303-446-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1464152WC0802X, 152WL0500X, 152WP0200X, 152WV0400X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT83821Medicare UPIN
COC43253Medicare PIN