MEDICARE: DALE G. LERVICK, O.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9977799	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306019047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALE G. LERVICK, O.D., P.C.

Provider Business Mailing Address
First Line	:	7586 W JEWELL AVE
Second Line	:	STE 104
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-6890
Country	:	US
Telephone Number	:	303-233-7575
Fax Number	:	303-233-4740

Provider Business Practice Location Address
First Line	:	7586 W JEWELL AVE
Second Line	:	STE 104
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-6890
Country	:	US
Telephone Number	:	303-233-7575
Fax Number	:	303-233-4740

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. DALE GORDON LERVICK
Credential	:	O.D.
Telephone Number	:	303-233-7575

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	04/26/2012

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