Provider Demographics
NPI:1528059573
Name:LANSING, MARY BETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:LANSING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:90 HEALTH PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9757
Mailing Address - Country:US
Mailing Address - Phone:303-666-1800
Mailing Address - Fax:303-666-8830
Practice Address - Street 1:90 HEALTH PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9757
Practice Address - Country:US
Practice Address - Phone:303-666-1800
Practice Address - Fax:303-666-8830
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO36103207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC51901OtherMEDICARE ID
CO01361039Medicaid
COC811156OtherMEDICARE PTAN
E87874Medicare UPIN