Healthcare Provider Details

I. General information

NPI: 1336106863
Provider Name (Legal Business Name): MARK G KRUCHEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7761 SHAFFER PKWY STE 200
LITTLETON CO
80127-3731
US

IV. Provider business mailing address

7761 SHAFFER PKWY STE 200
LITTLETON CO
80127-3731
US

V. Phone/Fax

Practice location:
  • Phone: 303-979-4505
  • Fax: 303-933-0714
Mailing address:
  • Phone: 303-979-4505
  • Fax: 303-933-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1169
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: