Healthcare Provider Details

I. General information

NPI: 1558406611
Provider Name (Legal Business Name): AMY MOK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 W. COLFAX AVE SUITE #309
LAKEWOOD CO
80401-3229
US

IV. Provider business mailing address

14500 W. COLFAX AVE SUITE #309
LAKEWOOD CO
80401-3229
US

V. Phone/Fax

Practice location:
  • Phone: 303-278-4191
  • Fax: 303-271-0433
Mailing address:
  • Phone: 303-278-4191
  • Fax: 303-271-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number373
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3237
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: