Healthcare Provider Details

I. General information

NPI: 1457335077
Provider Name (Legal Business Name): DENVER EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13772 DENVER WEST PKWY BLDG#55, STE#120
LAKEWOOD CO
80401-3139
US

IV. Provider business mailing address

13772 DENVER WEST PKWY STE 120
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JACKIE BECKER
Title or Position: BILLING MANAGER
Credential:
Phone: 303-273-8774