MEDICARE: DR. HERAN WINTA GEBREYESUS MD

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	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	D0100834	MD
2	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	DR.0070713	CO

General Provider Information

NPI Number	:	1235692229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERAN WINTA GEBREYESUS MD

Provider Business Mailing Address
First Line	:	13772 DENVER WEST PKWY STE 100
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3139
Country	:	US
Telephone Number	:	303-279-6600
Fax Number	:	303-279-9140

Provider Business Practice Location Address
First Line	:	13772 DENVER WEST PKWY STE 100
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3139
Country	:	US
Telephone Number	:	303-279-6600
Fax Number	:	303-279-9140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	06/09/2026

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