Healthcare Provider Details

I. General information

NPI: 1124003710
Provider Name (Legal Business Name): LARRY W KREIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13772 DENVER WEST PKWY BLDG#55 STE#100
LAKEWOOD CO
80401-3139
US

IV. Provider business mailing address

13772 DENVER WEST PKWY BLDG#55 STE#100
LAKEWOOD CO
80401-3139
US

V. Phone/Fax

Practice location:
  • Phone: 303-279-6600
  • Fax: 303-279-9140
Mailing address:
  • Phone: 303-279-6600
  • Fax: 303-279-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number16151
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: