Healthcare Provider Details

I. General information

NPI: 1528036829
Provider Name (Legal Business Name): ROGER ALAN HULME OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 N TAFT AVE
LOVELAND CO
80538-3121
US

IV. Provider business mailing address

2677 N TAFT AVE
LOVELAND CO
80538-3121
US

V. Phone/Fax

Practice location:
  • Phone: 970-667-5511
  • Fax: 970-292-5213
Mailing address:
  • Phone: 970-667-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1220
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1220
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: