Healthcare Provider Details

I. General information

NPI: 1962642603
Provider Name (Legal Business Name): MCCRACKEN EYE & FACE INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 LIONESS WAY SUITE 160
PARKER CO
80134-5640
US

IV. Provider business mailing address

11960 LIONESS WAY SUITE 160
PARKER CO
80134-5640
US

V. Phone/Fax

Practice location:
  • Phone: 720-851-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDR-41566
License Number StateCO

VIII. Authorized Official

Name: MICHAEL MCCRACKEN
Title or Position: PRESIDENT
Credential: MD
Phone: 303-916-1553