Healthcare Provider Details

I. General information

NPI: 1639745748
Provider Name (Legal Business Name): LEEANN TYRRELL OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 120TH AVE
THORNTON CO
80233-5711
US

IV. Provider business mailing address

18451 W 58TH CT
GOLDEN CO
80403-2157
US

V. Phone/Fax

Practice location:
  • Phone: 303-280-0971
  • Fax: 303-280-6757
Mailing address:
  • Phone: 303-818-2479
  • Fax: 303-280-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEEANN TYRRELL
Title or Position: OPTOMETRIST
Credential: OD
Phone: 303-818-2479