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General NPI Number Information
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NPI Number | 1316572803
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Entity Type | Organization
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Legal Business Name | COLORADO RETINA ASSOCIATES, PLLC
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 360 PEAK ONE DR STE 300
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City | FRISCO
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State | CO
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Zip | 80443-5948
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Country | US
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Telephone | 303-261-1600
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Fax | 303-261-1601
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Provider Business Mailing Address
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Address Line | PO BOX 17949
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City | DENVER
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State | CO
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Zip | 80217-0949
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Country | US
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Telephone | 303-261-1600
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Fax | 303-261-1601
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KYLIE ESPINOZA
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Credential |
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Telephone | 303-261-1600
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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 |
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License Number State |
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