MEDICARE: JENNIFER SLEBOS REDMOND O.D.

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	152W00000X	Optometrist	2055	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C450498	OTHER	CO	PTAN

General Provider Information

NPI Number	:	1629078019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SLEBOS REDMOND O.D.

Provider Business Mailing Address
First Line	:	24200 E SMOKY HILL RD
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-1381
Country	:	US
Telephone Number	:	720-870-2828
Fax Number	:	720-870-2117

Provider Business Practice Location Address
First Line	:	24200 E SMOKY HILL RD
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-1381
Country	:	US
Telephone Number	:	720-870-2828
Fax Number	:	720-870-2117

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/11/2012

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