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General NPI Number Information
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NPI Number | 1255509402
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DENVER EYE CENTER LLC
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 6179 S BALSAM WAY STE 130
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City | LITTLETON
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State | CO
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Zip | 80123-3092
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Country | US
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Telephone | 303-948-2020
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Fax | 720-981-4250
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Provider Business Mailing Address
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Address Line | PO BOX 621986
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City | LITTLETON
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State | CO
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Zip | 80162-1986
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Country | US
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Telephone | 303-948-2020
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Fax | 720-981-4250
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Authorized Official
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Title or Position | OWNER
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Name | ALFRED D ROBERTS
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Credential | M.D.
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Telephone | 303-948-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 28763
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License Number State | CO
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