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General NPI Number Information
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NPI Number | 1407842628
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Entity Type | Individual
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Provider Name | JON F PEDERSON OD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 6650 S VINE ST STE 160
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City | CENTENNIAL
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State | CO
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Zip | 80121-2769
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Country | US
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Telephone | 303-798-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 S COLUMBINE ST
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City | DENVER
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State | CO
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Zip | 80210-2419
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Country | US
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Telephone |
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2468
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License Number State | CO
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