Healthcare Provider Details

I. General information

NPI: 1376549055
Provider Name (Legal Business Name): LINWOOD PAGE POND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/28/2015
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

15320 E ALAMEDA PKWY
AURORA CO
80017-2066
US

IV. Provider business mailing address

15320 E ALAMEDA PKWY
AURORA CO
80017-2066
US

V. Phone/Fax

Practice location:
  • Phone: 303-745-9400
  • Fax: 303-369-5212
Mailing address:
  • Phone: 303-745-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCO1006
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: