Provider Demographics
NPI:1962519496
Name:STRUM, MARK STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:STRUM
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 1:6905 S. BROADWAY
Mailing Address - Street 2:SUITE 51
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-8000
Mailing Address - Country:US
Mailing Address - Phone:303-798-7520
Mailing Address - Fax:303-798-1503
Practice Address - Street 1:6905 S BROADWAY
Practice Address - Street 2:SUITE 51
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-8013
Practice Address - Country:US
Practice Address - Phone:303-798-7520
Practice Address - Fax:303-798-1503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO936152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60767Medicare UPIN
COCO40524Medicare PIN