Provider Demographics
NPI:1013027291
Name:PADDOCK, PAIGE MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:MICHELLE
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 LOIS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2124
Mailing Address - Country:US
Mailing Address - Phone:303-859-9542
Mailing Address - Fax:
Practice Address - Street 1:7653 W 88TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-1684
Practice Address - Country:US
Practice Address - Phone:303-422-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40501Medicare PIN