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General NPI Number Information
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NPI Number | 1346392438
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Entity Type | Organization
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Legal Business Name | LUERSSEN INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2720 S COLORADO BLVD 704
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City | DENVER
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State | CO
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Zip | 80222-6627
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Country | US
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Telephone | 303-758-1292
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Fax | 303-758-0167
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Provider Business Mailing Address
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Address Line | 2720 S COLORADO BLVD 704
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City | DENVER
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State | CO
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Zip | 80222-6627
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Country | US
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Telephone | 303-758-1292
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Fax | 303-758-0167
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Authorized Official
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Title or Position | OWNER,OPERATOR
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Name | BRAD LUERSSEN
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Credential |
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Telephone | 303-758-1292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 21538790000
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License Number State | CO
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