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General NPI Number Information
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NPI Number | 1710436449
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL OPTIQUE INC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 7800 E HAMPDEN AVE
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City | DENVER
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State | CO
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Zip | 80231-4885
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Country | US
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Telephone | 303-755-9880
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Fax | 303-338-5994
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Provider Business Mailing Address
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Address Line | 7800 E HAMPDEN AVE
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City | DENVER
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State | CO
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Zip | 80231-4885
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Country | US
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Telephone | 303-755-9880
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Fax | 303-338-5994
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BEVERLY JO ROULEAU
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Credential | OWNER
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Telephone | 303-921-6869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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