Healthcare Provider Details

I. General information

NPI: 1548376965
Provider Name (Legal Business Name): PAUL S CONKLING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/07/2023
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: 303-393-8378
  • Fax: 720-872-4902
Mailing address:
  • Phone: 303-393-8378
  • Fax: 720-872-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number15699
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: