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General NPI Number Information
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NPI Number | 1942407341
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Entity Type | Organization
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Legal Business Name | CHERRY CREEK OPTICAL
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 4999 E KENTUCKY AVE SUITE 100
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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 | 303-691-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 4999 E KENTUCKY AVE SUITE 100
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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 | 303-691-2233
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Fax |
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 21624440000
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License Number State | CO
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