Healthcare Provider Details

I. General information

NPI: 1952512378
Provider Name (Legal Business Name): OPTICAS LUX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 BROADWAY
DENVER CO
80203-3404
US

IV. Provider business mailing address

414 BROADWAY
DENVER CO
80203-3404
US

V. Phone/Fax

Practice location:
  • Phone: 720-570-2595
  • Fax: 720-570-2770
Mailing address:
  • Phone: 720-570-2595
  • Fax: 720-570-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateCO

VIII. Authorized Official

Name: MR. GUILLERMO AMEZAGA
Title or Position: OWNER
Credential:
Phone: 720-570-2595