Healthcare Provider Details

I. General information

NPI: 1003170366
Provider Name (Legal Business Name): ABED NAMAVARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 S SYRACUSE WAY STE 102
GREENWOOD VILLAGE CO
80111-4747
US

IV. Provider business mailing address

6021 S SYRACUSE WAY STE 102
GREENWOOD VILLAGE CO
80111-4747
US

V. Phone/Fax

Practice location:
  • Phone: 720-667-3852
  • Fax: 303-648-6462
Mailing address:
  • Phone: 720-667-3852
  • Fax: 303-648-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0061258
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberDR.0061258
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: