Healthcare Provider Details

I. General information

NPI: 1457572695
Provider Name (Legal Business Name): MANSI B PARIKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DRY CREEK DR
LONGMONT CO
80503-6499
US

IV. Provider business mailing address

1400 DRY CREEK DR
LONGMONT CO
80503-6499
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-3300
  • Fax: 303-682-3380
Mailing address:
  • Phone: 303-772-3300
  • Fax: 303-682-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125-050274
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number37734
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD 60096106
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number71862
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberDR.0061896
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: