Provider Demographics
NPI:1386234219
Name:DENVER EYE CARE OD PLLC
Entity type:Organization
Organization Name:DENVER EYE CARE OD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-859-1413
Mailing Address - Street 1:539 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0269
Mailing Address - Country:US
Mailing Address - Phone:704-812-7778
Mailing Address - Fax:704-812-7779
Practice Address - Street 1:539 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-812-7778
Practice Address - Fax:704-812-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255769469OtherNPI TYPE 1