Healthcare Provider Details

I. General information

NPI: 1114962651
Provider Name (Legal Business Name): CHILDREN'S EYE PHYSICIANS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 WARD RD SUITE 600
WHEAT RIDGE CO
80033-1942
US

IV. Provider business mailing address

4875 WARD RD SUITE 600
WHEAT RIDGE CO
80033-1942
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-9456
  • Fax: 303-463-7560
Mailing address:
  • Phone: 303-456-9456
  • Fax: 303-463-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04010328
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MRS. LYNETTE BRIDGES
Title or Position: PRACTICE ADMINISTRATOR/CEO
Credential:
Phone: 303-463-5784