Healthcare Provider Details

I. General information

NPI: 1609700186
Provider Name (Legal Business Name): JADE CORPUS-SAPIDA OD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 29TH ST UNIT 1046
BOULDER CO
80301-1027
US

IV. Provider business mailing address

1750 29TH ST UNIT 1046
BOULDER CO
80301-1027
US

V. Phone/Fax

Practice location:
  • Phone: 720-606-2863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0004208
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: