Healthcare Provider Details

I. General information

NPI: 1154474187
Provider Name (Legal Business Name): KEVIN C. POLLARD O.D., F.A.A.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 XAVIER ST SUITE 101
DENVER CO
80204-1024
US

IV. Provider business mailing address

1516 XAVIER ST SUITE 101
DENVER CO
80204-1024
US

V. Phone/Fax

Practice location:
  • Phone: 303-446-8688
  • Fax:
Mailing address:
  • Phone: 303-446-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1464
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1464
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1464
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1464
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1464
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: