Healthcare Provider Details

I. General information

NPI: 1003778135
Provider Name (Legal Business Name): COLORADO OCULOFACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E CHERRY CREEK SOUTH DR STE 550
DENVER CO
80246-1524
US

IV. Provider business mailing address

4500 E CHERRY CREEK SOUTH DR
DENVER CO
80246-1518
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-1616
  • Fax: 303-839-1991
Mailing address:
  • Phone: 303-839-1616
  • Fax: 303-839-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FANTE
Title or Position: MD
Credential: MD
Phone: 303-839-1616