Provider Demographics
NPI:1912122763
Name:DINNEBECK, MILDRED IVONNE (OD)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:IVONNE
Last Name:DINNEBECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MILDRED
Other - Middle Name:IVONNE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1815 65TH AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7964
Mailing Address - Country:US
Mailing Address - Phone:970-330-7200
Mailing Address - Fax:970-330-7201
Practice Address - Street 1:1815 65TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7964
Practice Address - Country:US
Practice Address - Phone:970-330-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0001706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist