Healthcare Provider Details

I. General information

NPI: 1588595268
Provider Name (Legal Business Name): GHEENA SANTHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 N NEVADA AVE
COLORADO SPRINGS CO
80907-4310
US

IV. Provider business mailing address

1930 DAPPLEGREY LN
AUSTIN TX
78727-4592
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number721344
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: