Healthcare Provider Details

I. General information

NPI: 1245295914
Provider Name (Legal Business Name): VANDI RIMER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S YOSEMITE ST
CENTENNIAL CO
80112-1406
US

IV. Provider business mailing address

6881 S YOSEMITE ST
CENTENNIAL CO
80112-1406
US

V. Phone/Fax

Practice location:
  • Phone: 303-740-9310
  • Fax: 303-740-5494
Mailing address:
  • Phone: 303-740-9310
  • Fax: 303-740-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2381
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: