Healthcare Provider Details

I. General information

NPI: 1336262393
Provider Name (Legal Business Name): AUDREY LOIS DOCKINS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N ACADEMY BLVD
COLORADO SPGS CO
80909-3313
US

IV. Provider business mailing address

1315 N ACADEMY BLVD
COLORADO SPGS CO
80909-3313
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-6987
  • Fax: 719-597-7190
Mailing address:
  • Phone: 719-597-6987
  • Fax: 719-597-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberCO2264
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberCO2264
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberCO2264
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberCO2264
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCO2264
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: