Healthcare Provider Details

I. General information

NPI: 1235728189
Provider Name (Legal Business Name): MILE HIGH RETINA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4999 E KENTUCKY AVE STE 200
DENVER CO
80246-2281
US

IV. Provider business mailing address

1266 S GAYLORD ST
DENVER CO
80210-1829
US

V. Phone/Fax

Practice location:
  • Phone: 303-691-0777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK PATRON
Title or Position: OWNER
Credential: MD
Phone: 303-301-4460