Healthcare Provider Details

I. General information

NPI: 1568452563
Provider Name (Legal Business Name): JERRY MICHAEL BELL O. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL BELL O.D.

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 CROWN CREST BLVD STE 150
PARKER CO
80138
US

IV. Provider business mailing address

10371 S PARK GLENN WAY SUITE 190
PARKER CO
80138-3869
US

V. Phone/Fax

Practice location:
  • Phone: 303-840-6268
  • Fax: 303-840-5385
Mailing address:
  • Phone: 303-840-6268
  • Fax: 303-840-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2113
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: