Healthcare Provider Details

I. General information

NPI: 1053833681
Provider Name (Legal Business Name): BETTY BOCONG ZHANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MADISON ST STE 355
DENVER CO
80206-5429
US

IV. Provider business mailing address

4363 S QUEBEC ST APT 1215
DENVER CO
80237-2647
US

V. Phone/Fax

Practice location:
  • Phone: 303-377-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3330
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: