Healthcare Provider Details

I. General information

NPI: 1902807332
Provider Name (Legal Business Name): JEFFREY CRAIG MARLATT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 STATION ST SUITE 150
LONETREE CO
80124-6808
US

IV. Provider business mailing address

9400 STATION ST SUITE 150
LONETREE CO
80124-6808
US

V. Phone/Fax

Practice location:
  • Phone: 303-925-0075
  • Fax: 303-925-0079
Mailing address:
  • Phone: 303-925-0075
  • Fax: 303-925-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2038
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2038
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: