Healthcare Provider Details

I. General information

NPI: 1326398967
Provider Name (Legal Business Name): ANNE-MARIE PALMER O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 MAIN ST
LONGMONT CO
80501-2035
US

IV. Provider business mailing address

2221 E BIJOU ST STE 100
COLORADO SPRINGS CO
80909-8009
US

V. Phone/Fax

Practice location:
  • Phone: 303-834-6400
  • Fax: 303-834-6414
Mailing address:
  • Phone: 719-576-1850
  • Fax: 719-955-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0002995
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: