Healthcare Provider Details

I. General information

NPI: 1629078019
Provider Name (Legal Business Name): JENNIFER SLEBOS REDMOND O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24200 E SMOKY HILL RD
AURORA CO
80016-1381
US

IV. Provider business mailing address

24200 E SMOKY HILL RD
AURORA CO
80016-1381
US

V. Phone/Fax

Practice location:
  • Phone: 720-870-2828
  • Fax: 720-870-2117
Mailing address:
  • Phone: 720-870-2828
  • Fax: 720-870-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2055
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: