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General NPI Number Information
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NPI Number | 1831389030
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Entity Type | Organization
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Legal Business Name | CHESTER T ROE III MD L L C
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 4999 E KENTUCKY AVE SUITE 203
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City | DENVER
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State | CO
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Zip | 80246-2281
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Country | US
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Telephone | 303-758-5477
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Fax | 303-758-3069
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Provider Business Mailing Address
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Address Line | 4999 E KENTUCKY AVE SUITE 203
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City | DENVER
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State | CO
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Zip | 80246-3901
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Country | US
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Telephone | 303-758-5477
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Fax | 303-758-3069
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHESTER T ROE III
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Credential | M.D.
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Telephone | 303-758-5477
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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 | 1145
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 24061
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License Number State | CO
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