Healthcare Provider Details

I. General information

NPI: 1063618684
Provider Name (Legal Business Name): WAYNE LEW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 FILLMORE ST GL5
DENVER CO
80206-1514
US

IV. Provider business mailing address

1246 W 133RD WAY
WESTMINSTER CO
80234-1150
US

V. Phone/Fax

Practice location:
  • Phone: 303-316-2615
  • Fax: 303-331-9019
Mailing address:
  • Phone: 303-653-3368
  • Fax: 303-331-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCP002270
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: