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General NPI Number Information
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NPI Number | 1396230421
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Entity Type | Individual
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Provider Name | KALEB SULAK ABBOTT OD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2018
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 1675 AURORA CT
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City | AURORA
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State | CO
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Zip | 80045-2517
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Country | US
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Telephone | 720-848-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 7887 E BELLEVIEW AVE STE 180
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City | ENGLEWOOD
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State | CO
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Zip | 80111-6016
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Country | US
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Telephone | 303-486-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT.0003402
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License Number State | CO
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