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General NPI Number Information
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NPI Number | 1770702581
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Entity Type | Organization
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Legal Business Name | COLORADO LASER SURGEONS
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 55 MADISON ST #300
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City | DENVER
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State | CO
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Zip | 80206-5419
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Country | US
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Telephone | 303-393-8565
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Fax |
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Provider Business Mailing Address
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Address Line | 55 MADISON ST #300
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City | DENVER
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State | CO
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Zip | 80206-5419
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Country | US
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Telephone | 303-393-8565
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Fax |
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Authorized Official
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Title or Position | CENTER DIRECTOR
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Name | KETTY LEE STREIFEL
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Credential | OD
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Telephone | 303-393-8565
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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 | 1906
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License Number State | CO
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