Healthcare Provider Details

I. General information

NPI: 1861520942
Provider Name (Legal Business Name): JENNIFER BLAUROCK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8370 NORTHFIELD BLVD STE 1795
DENVER CO
80238-3132
US

IV. Provider business mailing address

577 W WILLOW CT
LOUISVILLE CO
80027-1668
US

V. Phone/Fax

Practice location:
  • Phone: 303-373-1700
  • Fax:
Mailing address:
  • Phone: 760-285-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 11042 TPA
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2975
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: