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General NPI Number Information
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NPI Number | 1083808562
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Entity Type | Organization
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Legal Business Name | PHILIP WREN, O.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 8501 W BOWLES AVE STE 1B-204
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City | LITTLETON
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State | CO
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Zip | 80123-9502
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Country | US
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Telephone | 303-979-1550
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Fax | 303-979-1850
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Provider Business Mailing Address
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Address Line | 620 11TH ST UNIT 202
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City | GOLDEN
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State | CO
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Zip | 80401-0704
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Country | US
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Telephone | 303-979-1550
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Fax | 303-979-1850
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP WREN
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Credential | O.D.
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Telephone | 303-979-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12089T
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License Number State | CA
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