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General NPI Number Information
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NPI Number | 1134353626
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Entity Type | Organization
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Legal Business Name | ELITE OCULOPLASTIC SURGERY, PC
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 5690 DTC BLVD SUITE 130W
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City | ENGLEWOOD
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State | CO
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Zip | 80111
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Country | US
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Telephone | 303-500-5042
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Fax | 303-872-6717
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Provider Business Mailing Address
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Address Line | 5690 DTC BLVD SUITE 130W
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City | ENGLEWOOD
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State | CO
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Zip | 80111
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Country | US
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Telephone | 303-500-5042
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Fax | 303-872-6717
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE H WHITE
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Credential | MD
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Telephone | 303-856-6850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 45241
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License Number State | CO
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