Healthcare Provider Details

I. General information

NPI: 1366069833
Provider Name (Legal Business Name): MEGAN RILEY SULLIVAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 S BROADWAY
HIGHLANDS RANCH CO
80129-5651
US

IV. Provider business mailing address

11862 E FAIR AVE
GREENWOOD VILLAGE CO
80111-5716
US

V. Phone/Fax

Practice location:
  • Phone: 303-683-4466
  • Fax: 303-683-4467
Mailing address:
  • Phone: 214-708-3907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9973T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: