Healthcare Provider Details

I. General information

NPI: 1720514979
Provider Name (Legal Business Name): EMMELINE SIEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMELINE CRUZ

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E ARAPAHOE RD
CENTENNIAL CO
80122-2312
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3800
  • Fax:
Mailing address:
  • Phone: 303-338-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5301
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003990
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: