Healthcare Provider Details

I. General information

NPI: 1740373794
Provider Name (Legal Business Name): DAVID N HINKLEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 WASHINGTON ST
MONTE VISTA CO
81144-1406
US

IV. Provider business mailing address

37 WASHINGTON ST
MONTE VISTA CO
81144-1406
US

V. Phone/Fax

Practice location:
  • Phone: 719-852-3442
  • Fax: 719-852-9791
Mailing address:
  • Phone: 719-852-3442
  • Fax: 719-852-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT1289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: