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General NPI Number Information
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NPI Number | 1780393264
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Entity Type | Organization
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Legal Business Name | SIMPLE OPTICAL, INC
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 6460 E YALE AVE UNIT A20
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City | DENVER
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State | CO
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Zip | 80222-7145
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Country | US
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Telephone | 720-316-7739
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Fax |
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Provider Business Mailing Address
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Address Line | 1057 W CENTURY DR APT 118
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City | LOUISVILLE
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State | CO
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Zip | 80027-1639
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Country | US
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Telephone | 303-601-1982
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP WREN
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Credential | OD
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Telephone | 303-601-1982
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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 |
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License Number State |
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