Provider Demographics
NPI:1508690017
Name:STOFFREGEN EYECARE LLC
Entity type:Organization
Organization Name:STOFFREGEN EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STOFFREGEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-721-3684
Mailing Address - Street 1:14028 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8854
Mailing Address - Country:US
Mailing Address - Phone:816-721-3684
Mailing Address - Fax:
Practice Address - Street 1:200 W 136TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1204
Practice Address - Country:US
Practice Address - Phone:720-929-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STOFFREGEN EYECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty