Healthcare Provider Details

I. General information

NPI: 1992763403
Provider Name (Legal Business Name): CYNTHIA A CID OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA A GILLUM OD

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 RESEARCH PKWY STE 200
COLORADO SPRINGS CO
80920-1094
US

IV. Provider business mailing address

2438 RESEARCH PKWY STE 200
COLORADO SPRINGS CO
80920-1094
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-5083
  • Fax: 719-599-3291
Mailing address:
  • Phone: 719-599-5083
  • Fax: 719-599-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2510
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: