Healthcare Provider Details

I. General information

NPI: 1467415802
Provider Name (Legal Business Name): THOMAS A POLITZER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 E ASPEN AVE STE 100
FRUITA CO
81521-2204
US

IV. Provider business mailing address

332 E ASPEN AVE STE 100
FRUITA CO
81521-2204
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-2020
  • Fax: 970-858-6601
Mailing address:
  • Phone: 970-858-2020
  • Fax: 970-858-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1105
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: