Healthcare Provider Details

I. General information

NPI: 1114910759
Provider Name (Legal Business Name): CORNEAL CONSULTANTS OF COLORADO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W MINERAL AVE STE 100
LITTLETON CO
80120-5612
US

IV. Provider business mailing address

1501 W MINERAL AVE STE 100
LITTLETON CO
80120-5612
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-0404
  • Fax: 720-647-4210
Mailing address:
  • Phone: 303-730-0404
  • Fax: 303-730-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHAN LANCE FORSTOT
Title or Position: PRESIDENT
Credential: MD
Phone: 303-730-0404