Healthcare Provider Details

I. General information

NPI: 1861545089
Provider Name (Legal Business Name): UYEN THU CAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5790 W 44TH AVE
DENVER CO
80212-7340
US

IV. Provider business mailing address

1602 TULLAMORE AVE
BLOOMINGTON IL
61704-9624
US

V. Phone/Fax

Practice location:
  • Phone: 303-421-4422
  • Fax: 303-431-1457
Mailing address:
  • Phone: 309-808-3112
  • Fax: 312-327-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2458
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: