MEDICARE: OPTICIANS 2

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1033571773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICIANS 2

Provider Business Mailing Address
First Line	:	834 S PERRY ST STE E
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1941
Country	:	US
Telephone Number	:	303-688-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	834 S PERRY ST STE E
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1941
Country	:	US
Telephone Number	:	303-688-0707
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHLEEN FINCHER
Credential	:
Telephone Number	:	303-688-0707

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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