=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235122045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID WILLIAM HIMEL OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1407 W 84TH AVE UNIT B8
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80260-4753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-214-4746
-----------------------------------------------------
Fax | 720-214-4745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1280 CENTAUR VILLAGE DR STE 2
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80026-3175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-604-1060
-----------------------------------------------------
Fax | 720-890-8153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MH0193514
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT.0001403
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------