Healthcare Provider Details

I. General information

NPI: 1134353626
Provider Name (Legal Business Name): ELITE OCULOPLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5690 DTC BLVD SUITE 130W
ENGLEWOOD CO
80111
US

IV. Provider business mailing address

5690 DTC BLVD SUITE 130W
ENGLEWOOD CO
80111
US

V. Phone/Fax

Practice location:
  • Phone: 303-500-5042
  • Fax: 303-872-6717
Mailing address:
  • Phone: 303-500-5042
  • Fax: 303-872-6717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number45241
License Number StateCO

VIII. Authorized Official

Name: MICHELLE H WHITE
Title or Position: OWNER
Credential: MD
Phone: 303-856-6850