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General NPI Number Information
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NPI Number | 1245942689
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Entity Type | Organization
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Legal Business Name | INFINITY EYECARE OF DENVER PLLC
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 564 S BROADWAY
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City | DENVER
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State | CO
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Zip | 80209-4002
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Country | US
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Telephone | 303-777-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 2755 S GILPIN ST
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City | DENVER
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State | CO
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Zip | 80210-6313
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Country | US
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Telephone | 303-777-1400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY BISTODEAU
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Credential | O.D.
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Telephone | 406-799-1621
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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 |
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License Number State |
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