MEDICARE: DR. MICHAEL J WAZNY 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	1017	CO

General Provider Information

NPI Number	:	1710942321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J WAZNY O.D.

Provider Business Mailing Address
First Line	:	3190 S WADSWORTH BLVD
Second Line	:	SUITE 320
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4899
Country	:	US
Telephone Number	:	303-988-5858
Fax Number	:	303-988-3651

Provider Business Practice Location Address
First Line	:	3190 S WADSWORTH BLVD
Second Line	:	SUITE 320
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4899
Country	:	US
Telephone Number	:	303-988-5858
Fax Number	:	303-988-3651

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	10/20/2010

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