=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184292385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEREK MICHAEL HOWARD OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2021
-----------------------------------------------------
Last Update Date | 06/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 PRAIRIE CENTER PKWY UNIT A
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80601-7023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-685-3152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7286 PINE HILLS WAY
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80125-8999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-229-9255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0003693
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------