Healthcare Provider Details

I. General information

NPI: 1063073245
Provider Name (Legal Business Name): JADE MCLACHLIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 TUTT BLVD STE 220
COLORADO SPRINGS CO
80923-3502
US

IV. Provider business mailing address

6160 TUTT BLVD STE 201
COLORADO SPRINGS CO
80923-3500
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-5068
  • Fax:
Mailing address:
  • Phone: 719-598-5068
  • Fax: 719-632-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003504
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: