MEDICARE: DR. VICKI L COULTER 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	207W00000X	Ophthalmology Physician	32160	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	K2868	OTHER	CO	MEDICARE LEGACY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326023912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI L COULTER MD

Provider Business Mailing Address
First Line	:	13772 DENVER WEST PKWY
Second Line	:	BLDG#55 STE#100
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
Second Line	:	BLDG#55 STE#100
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	:	12/07/2005
Last Update Date	:	12/17/2007

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Directions to “ DR. VICKI L COULTER MD” Practice Location

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