Healthcare Provider Details

I. General information

NPI: 1194039040
Provider Name (Legal Business Name): NILS REGE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 N ACADEMY BLVD
COLORADO SPRINGS CO
80920-3187
US

IV. Provider business mailing address

7238 N ACADEMY BLVD
COLORADO SPRINGS CO
80920-3187
US

V. Phone/Fax

Practice location:
  • Phone: 719-592-9991
  • Fax: 719-260-6251
Mailing address:
  • Phone: 719-592-9991
  • Fax: 719-260-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3181
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: