Provider Demographics
NPI:1699951004
Name:BARDASH, JOHN JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:BARDASH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 E YALE AVE
Mailing Address - Street 2:STE. A20
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7156
Mailing Address - Country:US
Mailing Address - Phone:720-316-7739
Mailing Address - Fax:720-259-9360
Practice Address - Street 1:6460 E YALE AVE
Practice Address - Street 2:STE. A20
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7156
Practice Address - Country:US
Practice Address - Phone:720-316-7739
Practice Address - Fax:720-259-9360
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA109315OtherINDIVIDUAL PTAN