=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811523640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENVER EYE CARE SPECIALISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2020
-----------------------------------------------------
Last Update Date | 06/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2171 PRAIRIE CENTER PKWY
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80601-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-770-8649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3453 ULSTER ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80238-2784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OD
-----------------------------------------------------
Name | ELINA KOLESNIKOV DAVIDOFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-770-8649
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------